Amenorrhea is during puberty and menopause, when menstruation is absent during reproductive years.
It’s not a disease and it doesn’t mean a person is infertile, but it may be a symptom of a health condition that needs some attention.
Menstruation starts during puberty, and then usually happens around once a month until the age of 50 years. Periods cease entirely at this time, as menopause begins.
Menstruation also stops during pregnancy and it’s also normal for it to stop during breastfeeding.
It is amenorrhea if menstruation does not occur at times when people usually expect it.
Types of amenorrhea
There are two types of amenorrhea: primary and secondary.
Primary amenorrhea
Main amenorrea is when cycles during puberty do not start.
When cycles do not start by the age of 16 years, the individual should seek medical attention, according to the National Institutes of Health.
Primary amenorrhea is fairly rare. It affects less than 0.1 percent of people in the United States.
Secondary amenorrhea
This is when the cycles begin but then they cease to take place.
It is common during pregnancy or breastfeeding, but it may also mean a issue is present.
Secondary amenorrhea is estimated to affect about 4 percent of women in the U.S. over their lifetime.
One missed day is typically not a sign of a health concern, but if it occurs, many people will ask for a pregnancy test.
A doctor will consider secondary amenorrhea if an individual:
- used to have regular periods and then does not have any for 3 months
- used to have irregular periods and then does not have any for 6 months
Causes of amenorrhea
The cause will probably be different for primary and secondary amenorrhea.
Primary amenorrhea
One common cause of primary amenorrhea is a delayed menstrual family history. There is, however, also a genetic issue.
Genetic conditions which can stop ovaries from working properly include:
- Turner syndrome
- androgen insensitivity syndrome, which leads to high levels of testosterone
- Müllerian defects
A Müllerian anomaly is a reproductive-organ malformation. The uterus and fallopian tubes are not forming as they should.
A structural issue can occur in relation to the genitals that are present from birth. The uterus and Fallopian tubes can sometimes be absent. Often there are fusion problems, where the tubes don’t work together properly.
The ovaries, breasts, and clitoris shape correctly in the Müllerian agenesis, or Mayer-Rokitansky-KusterHauser (MRKH) syndrome, but there is no vaginal opening, and the cervix and uterus may not develop properly.
In this case the usual pattern does not match reproductive development, and menstruation will not be possible.
Secondary amenorrhea
Menstruation may stop for a number of reasons.
These include:
The risk of developing secondary amenorrhea increases considerably when BMI falls below 19.
Weight loss, exercise, and stress
Severe weight loss may be the result of an eating disorder or a physical disability.
Strict exercise can cause subsequent amenorrhea. Competitive long-distance runners and experienced ballet dancers are popular here.
Severe emotional upheaval or intense stress can also cause a woman to interrupt her cycles.
Medications
Many medicines, such as progesterone-only contraception and a variety of psychiatric medications, may cause disruption of periods.
Other medicinal products which affect menstruation include:
- antipsychotics
- cancer chemotherapy
- antidepressants
- blood pressure drugs
- allergy medications
Long-term health conditions
Amenorrhea can also result from a long-term illness, such as:
- polycystic ovary syndrome (PCOS)
- premature ovarian failure
- thalamic pituitary problems
Pituitary problems or an underactive thyroid can lead to a hormone imbalance, and it can result in menstrual problems.
These could be due to:
- a benign or cancerous tumor in the pituitary gland
- an over- or under-active thyroid gland
Symptoms
The main symptom is a lack of menstruation.
However, depending on the cause, other symptoms may occur.
These include:
- milky nipple discharge
- hair loss
- a headache
- vision changes
- additional facial hair
In those with primary amenorrhea, there may be a lack of breast development.
Anyone who experiences these symptoms should seek medical advice.
Diagnosis
Amenorrhea is not an disease but a symptom. The doctor’s goal is to figure out why menstruation doesn’t happen.
Primary amenorrhea
If an person has not begun menstruating by the age of 16, a doctor can ask about their family history and conduct a series of tests.
This will include tests to assess the levels of the hormones in question:
- follicle stimulating hormone (FSH)
- luteinizing hormone (LH)
- thyroid stimulating hormone (TSH)
They will also carry out a physical examination.
Secondary amenorrhea
A secondary amenorrhea diagnosis should focus on the underlying cause of the problem.
The physician could ask questions before conducting any tests, to find out:
- at what age menstruation started
- whether the person is sexually active
- if pregnancy is a possibility
- if weight loss or weight gain has occurred, and what kind of exercise routine the person follows
- the length and regularity of the menstrual cycle and whether bleeding is heavy or light
They may then recommend a number of tests, depending on what the cause appears to be.
These may include:
- a pregnancy test
- a thyroid function test
- ovary function test
- androgen and other hormone tests
Imaging tests may include:
- an MRI, CT, or ultrasound scan
- a hysteroscopy, in which the doctor passes a thin, lighted camera through the vagina and cervix to examine the uterus from the inside
Treatment
Treatment will depend on the cause.
Primary amenorrhea
Primary amenorrhea treatment will start with watchful waiting, depending on the age of the person and the ovary function test result. If there is a late menstruation family history, the cycles can start in time.
If genetic or physical problems involving the reproductive organs can require surgery. However, that won’t guarantee that there will be regular menstrual cycles.
Secondary amenorrhea
That is going to rely on the underlying cause.
Factors of lifestyle: If the individual is exercising regularly, a change in the exercise plan or diet may help stabilize the monthly period.
Stress: If an issue relates to emotional or mental stress, therapy can help.
Excessive weight loss: This can occur for multiple reasons. The individual may need a weight gaining program which is professionally monitored. If there is a possibility of an eating disorder, treatment may include a weight gain regime and counseling sessions with a psychiatrist and a nutritionist or dietitian.
Some health conditions can result in weight loss. For these, a doctor can test and offer treatment, as needed.
Underactive thyroid: If menstruation stops due to an underactive thyroid, the doctor can prescribe thyroxine, a thyroid hormone, for treatment.
Polycystic ovary syndrome (PCOS): The health care provider should recommend adequate treatment. If the PCOS has contributed to excess weight, a weight-loss diet can be prescribed.
Premature ovarian failure: Hormone replacement therapy ( HRT) can cause a return to menstruation.
Menopause: Menopause starts at age 50 but may often start as early as 40 years. That can be influenced by family history.
If the menopause begins early, the risk of osteoporosis is higher. To avoid this complication the individual may need care.
Takeaway
There are a variety of reasons why menstruation can end. It doesn’t automatically mean an person is infertile and can’t conceive.
The person should seek medical advice if normal periods cease for 3 months or more, or if irregular periods stop for at least 6 months.
Treatment is available in many situations.
