Amenorrhea

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Amenorrhea is the prolonged absence of a menstrual period. Learn about amenorrhea, possible causes and how it can be treated.

Key points

  • Amenorrhea means a prolonged absence of a menstrual period.
  • Primary amenorrhea is when menstruation doesn’t start by age 15. Secondary amenorrhea is when menstruation has been happening regularly and then stops for more than three months.
  • It is important to see your health-care provider if you are not having regular periods.
  • Amenorrhea can happen for many reasons; sometimes it’s normal but in other cases you may need treatment for an underlying condition.
  • Treatment will depend on your age and what is causing amenorrhea.

What is amenorrhea?

Amenorrhea is a menstrual condition in which a person does not have a regular menstrual period.

There are two types of amenorrhea:

  • Primary amenorrhea is when menstruation has not started by age 15.
  • Secondary amenorrhea is when regular periods begin and then they stop for more than three months.

Often, when someone first starts getting their period, they don’t come entirely regularly every month. Once periods do become regular, they should continue to come regularly. If you have missed 3 periods in a row after having regular periods, or if you are 15 and have not had a period yet, it’s important that you contact your health-care provider to make an appointment to get checked out.

What causes amenorrhea

Menstruation may stop for several reasons including the following:

  • Pregnancy: If a person has had penile-vaginal sex, amenorrhea could mean that they are pregnant.
  • Contraception (birth control): Some forms of birth control , such as intrauterine devices, implants, injectable contraception and continuous pills, may cause a person to miss their period. This is a normal side effect of these forms of birth control.
  • Medications: Some medications and supplements may cause amenorrhea so it’s important to tell your health-care provider about all medications, supplements and/or herbs you may be taking.
  • Weight change: If a person has gained or lost a significant amount of weight, they may skip a period or not have periods. Weight changes can be caused by chronic illness, stress or not eating properly, disordered eating or an eating disorder such as anorexia nervosa or bulimia nervosa.
  • Excessive exercise: Sometimes athletes can have missed periods because their weight is too low, they aren’t taking in enough nutrition or because of stress.
  • Polycystic ovarian syndrome (PCOS) : This is a hormonal disorder that can affect ovulation and cause missed periods.
  • Underactive thyroid (hypothyroidism) or overactive thyroid (hyperthyroidism).
  • Congenital anomalies: A congenital anomaly, or birth defect, of the reproductive tract could include a vaginal obstruction or an underdeveloped or absent uterus. Although these anomalies are rare, a health-care provider may recommend an ultrasound to check that the reproductive tract is developed.
  • Stress: Significant stress can cause a person to miss their period. This can be because of life stress, such as stress about school, family issues or friends, or physical stress caused by illness or injury.

How is amenorrhea diagnosed?

Your health-care provider will want to understand why you are not having periods.

First, they will ask you about your medical history, menstruation, sexual activity, exercise and weight. They will also do a physical exam. In some cases, your health-care provider may need to do a pelvic exam or ultrasound to check that your reproductive organs all look healthy. Blood tests may also be necessary to check your hormone levels.

How is amenorrhea treated?

Treatment of amenorrhea will depend on what the cause is, your age, and other health factors. Treatments may involve either medications or lifestyle changes or both.

If amenorrhea is caused by issues with hormones, you may be referred to an endocrinologist, a doctor who specializes in hormones, for treatment. If your reproductive organs aren’t working properly or you’re diagnosed with congenital anomalies, you may be referred to a gynaecologist, a doctor who specializes in female reproductive health.

Last updated: January 26th 2023