Amenorrhea is the term used when a woman or adolescent girl is not having menstrual periods. There are two types of amenorrhea:
Other associated symptoms vary according to the cause. Primary ovarian insufficiency can cause hot flashes and vaginal dryness. An elevated prolactin level can lead to discharge of milk from the nipples. A pituitary tumor can result in headaches and vision changes. Polycystic ovary syndrome can cause acne and hair growth on the face and body. Many women have no symptoms other than the lack of menstrual periods.
Women naturally stop menstruating during pregnancy, long-term breastfeeding, and menopause. Birth control pills and injections and hormone-containing IUDs cause amenorrhea in some women. A number of other conditions can cause secondary amenorrhea.
Primary ovarian insufficiency, also called premature ovarian failure (menopause before age 40) can be caused by:
Long-term lack of ovulation (release of an egg from the ovary) due to disorders of the hypothalamus can be caused by:
Long-term lack of ovulation due to disorders of the pituitary can be caused by:
Abnormal balance of other hormones
Scarring of the uterus
Your doctor will ask questions about your medical history and do a physical exam. You will have a pregnancy test. Your doctor will likely order blood tests to check levels of FSH, estradiol, TSH, and prolactin. Blood tests also can measure androgen levels and check for thyroid or adrenal gland disorders.
If you are diagnosed with primary ovarian insufficiency , your doctor may check your chromosomes to see if a genetic abnormality is the cause. If your doctor thinks you may have a problem with your pituitary gland or hypothalamus, you will have an MRI, a brain imaging test. Some also have imaging tests of their reproductive organs.
The treatment depends on the cause of your amenorrhea. Options for treatment include:
Your doctor might also prescribe estrogen therapy to relieve hot flashes and vaginal dryness and to protect your bones. Calcium and vitamin D supplements, along with strength training, also help keep your bones strong. If you are trying to get pregnant, other treatments might be needed.
If you haven’t had your period for more than three months, see your doctor. Most causes of secondary amenorrhea can be detected easily and treated successfully.
The Hormone Health Network is the public education affiliate of the Endocrine Society dedicated to helping both patients and doctors find information on the prevention, treatment and cure of hormone-related conditions.
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