Absence of Menstrual Periods - Amenorrhea
- Overview, Causes, & Risk Factors
- Symptoms & Signs
- Diagnosis & Tests
- Prevention & Expectations
- Treatment & Monitoring
Overview, Causes, & Risk Factors
A woman who has amenorrhea has either never had a menstrual period or has stopped having periods.
What is going on in the body?
There are two categories of amenorrhea:
To have a period, a woman must have a normal, healthy:
An abnormality in any of these may keep a woman from having a period.
What are the causes and risks of the condition?
Primary amenorrhea is usually due to late puberty rather than any permanent problem. The reason for this delay is generally not known, though it may be a family trait. Other possible causes are:
Pregnancy is the most common reason for secondary amenorrhea. A woman's periods may also stop temporarily due to:
A woman's periods may not start up again for a while after she stops using birth control pills, shots or implants. Usually, periods will start again within 3 to 6 months.
Secondary amenorrhea may also be linked to:
Symptoms & Signs
What are the signs and symptoms of the condition?
Amenorrhea is not a disease. It is a symptom of certain health issues. Because it is often caused by a hormone imbalance, it may trigger other symptoms, such as:
Diagnosis & Tests
How is the condition diagnosed?
Amenorrhea is generally not life threatening, but it may be linked to certain health problems. When a woman reports it, her doctor will take a medical history and do a physical exam. He or she may also recommend:
These tests measure:
Some tumors of the pituitary gland may cause elevated prolactin levels. Special X-rays of the head can show tumors in the pituitary.
Prevention & Expectations
What can be done to prevent the condition?
By maintaining a healthy lifestyle, a woman may be able to avoid secondary amenorrhea. A woman should:
If this seems too hard, she should ask for guidance from friends, family, or healthcare professionals.
What are the long-term effects of the condition?
Long-term amenorrhea and estrogen-deficiency may raise a woman's risk of excess bone loss and osteoporosis. This makes bones more likely to break.
A woman who wishes to get pregnant may be resistant to drugs that help induce ovulation. If PCOS is causing the amenorrhea, long-term effects include:
What are the risks to others?
Treatment & Monitoring
What are the treatments for the condition?
If amenorrhea has lasted less than 6 months, a woman may not need treatment unless she has worrisome symptoms or a problem is found:
Depending on the cause of amenorrhea, treatment varies. Diet and exercise generally correct abnormal periods due to obesity. Stress management and not exercising too much helps, too.
Because ovaries are not producing eggs or certain hormones, a woman may be given:
Birth control pills and HRT drugs contain estrogen and progesterone or sometimes progesterone alone. The hormones may be used to:
Surgery may be required for:
Rarely, surgery is done when chromosome abnormalities are found.
What are the side effects of the treatments?
Hormones may cause minor side effects such as:
Occasionally, more serious side effects can occur with hormone therapy including blood clots, liver tumors, and endometrial cancer. Though these are quite rare, it is important for women to discuss the risks and benefits of hormone therapy with their healthcare provider.
Drugs to induce ovulation may trigger:
What happens after treatment for the condition?
When a younger woman has amenorrhea, normal periods often resume within a few years. Most women who are diagnosed and treated early can avoid surgery by taking hormones. If a woman wishes to get pregnant and not ovulating is the only infertility problem facing the couple, a success rate of 70% to 80% is possible.
After a woman stops taking birth control pills, she may not get a period for 2 to 3 months, though it may take a year or longer. If an unusual stress or illness has temporarily stopped a woman's periods, the problem will usually resolve on its own. It may recur at a later date.
How is the condition monitored?
If a woman misses more than one period, she should talk with her healthcare provider. It helps to:
Author:Eva Martin, MD
Editor:Coltrera, Francesca, BA
Reviewer:Adam Brochert, MD