What Is Amenorrhea? Symptoms, Causes, Diagnosis, Treatment, and Prevention

Amenorrhea is the medical term for the absence of a menstrual period. It can describe someone who has not gotten her first period by age 16, or for women who have previously menstruated, it refers to the absence of more than three consecutive menstrual cycles. (1)

Amenorrhea is not a disease, but in some cases it may be a symptom of another condition. It can occur in healthy women when they are pregnant, breastfeeding, on certain contraceptives, or experiencing the skipped periods in the time before menopause, known as perimenopause.

But in other women, amenorrhea can be a signal of trouble, especially if the missed menstruation appears with other symptoms. (1)

Doctors divide amenorrhea into two types: Primary amenorrhea refers to a condition in a girl who has never menstruated by the age of 16, or sometimes 14; and secondary amenorrhea generally refers to three months of missed periods, or sometimes fewer, in a woman who previously had a normal cycle. (2)

The absence of menstrual bleeding is labeled “amenorrhea.” But in some cases it is accompanied by other symptoms, indicating an underlying condition. For instance, women may have excess facial hair, headaches, hair loss, vision changes, or other symptoms in addition to the lack of a period. When this is the case, it is especially important to be checked by your healthcare provider. (1)

Some women have very light periods that may not last long, but if this is atypical for you or if you have had a change in your cycle, consult your healthcare provider.

RELATED: Is Your Period Normal?

Amenorrhea naturally occurs when a woman is pregnant or breastfeeding. Women who are on certain contraceptives or who have entered perimenopause, the years before their period ceases, may also experience months when they don’t get a menstrual period.

In other women, amenorrhea is a sign of disruption in the hormonal system in the body. This may be due to certain conditions or lifestyle challenges, such as excessively exercising, having an eating disorder, or experiencing significant stress. Typically when these issues are reversed, the menstrual period will return. (3)

Use of certain medications, including antipsychotics or drugs to treat certain cancers, can also stop your period for a time. (4)

Sometimes the dysfunction occurs for other reasons. Hormonal issues can stop menstruation in a previously regular woman, or it can be the cause of primary amenorrhea, where the menstrual period hasn’t yet begun.

Common hormonal problems causing amenorrhea include:

• Endocrine disorders, especially polycystic ovary syndrome (PCOS)
• Tumors in various hormone-producing glands, such as the hypothalamus, pituitary, or thyroid
• Primary ovarian insufficiency (also called premature ovarian failure)

Occasionally, primary amenorrhea results from a congenital anatomic abnormality of the reproductive system or from a genetic condition, such as fragile x syndrome. (3)

Insight into the cause of amenorrhea begins with answering questions with your healthcare provider, including your medical history, eating and exercise habits, and any medicines or supplements you may be taking. (5)

You’ll also want to report about your typical menstrual cycle, including how long it has been since your last period. This is why it’s smart for all women to regularly keep track of their cycle, either using a calendar or a period tracking app designed especially for this purpose.

You will also have a pelvic exam to check for physical defects. If birth defects are suspected in a teen with primary amenorrhea, a pelvic ultrasound might be performed.

Generally blood tests are also done, including a pregnancy test as well as those that measure a variety of hormones such as estradiol, follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid hormones, and others. (5)

If these tests do not uncover the cause of the amenorrhea, a head CT scan or MRI may be ordered to look for a tumor.

RELATED: How Keeping a Period Diary Helps Your Health

Once the cause of the amenorrhea has been identified and treated, the menstrual period should return.

Sometimes it requires addressing issues that are causing the lack of period, such as exercising excessively, being too thin or obese, or experiencing too much stress. (4)

Contraceptives may also result in amenorrhea. This is not dangerous, and your period will typically return about three months after you stop using them. (3)

RELATED: Speaking Menstruation: A Glossary of Terms Used to Describe Symptoms, Tests, Treatments, and More

Because many different conditions can be behind your missed periods, treatment varies depending on the cause. This ranges from medication, behavioral changes, and sometimes surgery.

Medication Options

• Birth control pills or other types of hormonal medication are often prescribed to restart an off-kilter menstrual cycle.
• Estrogen replacement therapy (ERT) may be given to women diagnosed with primary ovarian insufficiency. (6)
• Medication intended to shrink pituitary tumors, if necessary.
• Other medication may also be prescribed, depending on the disease your medical professional determines is causing your menstrual problems. (5)

Surgical Options

Surgery for amenorrhea is uncommon but may be recommended in certain situations:

• Uterine Scarring Removal of scar tissue resulting from a cesarean section, prior medical procedure, endometriosis, or other condition may be helpful in treating amenorrhea.
• Pituitary Tumor Surgery is sometimes needed to shrink a pituitary tumor if medication has not been successful. (6)

Alternative and Complementary Therapies

When lifestyle factors bring on amenorrhea, shifting to a healthier way of life can bring a regular cycle back. (6)

• A healthful diet, for women who are severely overweight or underweight, can achieve a healthier body mass index (BMI) and restore your periods.
• The right amount of exercise is useful for women who exercise extensively and lose too much weight, including competitive athletes and dancers.
• Stress reduction is an important way to keep periods flowing. Assess which parts of your life are causing you stress and see if you can change them. Programs like mindfulness-based stress reduction (MBSR) are designed to help.

To best regulate your menstrual cycle, maintain a healthy body weight and do a proper amount of exercise. (2)

Going without a period may not signal a health problem. When there is no natural explanation, though, it can be a sign that your hormonal or reproductive system is not working properly. The risks of having amenorrhea vary, depending on a woman’s estrogen state. For example, infertility or osteoporosis can occur from low estrogen, while endometrial cancer is related to high estrogen levels. (7,8)

Several underlying conditions that include amenorrhea as a symptom may cause significant complications.

Untreated PCOS, for instance, may result in excess estrogen production, which may lead to endometrial hyperplasia or cancer. (9) Women with PCOS are also often unable to use insulin effectively, which increases the risk of developing type 2 diabetes. (10)

Unintended pregnancy can be a result of amenorrhea if you are not carefully using birth control. It is still possible to get pregnant even when you are not having regular periods. (2)

• Anorexia
• Breastfeeding
• Bulimia
• Hypothalamic tumor
• Insulin resistance
• Metabolic syndrome
• Perimenopause
• Pregnancy
• Primary ovarian insufficiency (aka premature ovarian failure)
• Pituitary tumor
• Polycystic ovary syndrome (PCOS)
• Thyroid tumor
• Type 2 diabetes

Eunice Kennedy Shriver National Institute of Child Health and Human Development

Includes a comprehensive review of both primary and secondary amenorrhea for teens and adult women.

Merck Manual

This esteemed medical resource for professionals also has a detailed section on amenorrhea geared to consumers.