Absence of menstruation (amenorrhea) may be linked to an underlying, treatable problem. Learn about amenorrhea causes and when to seek help.
Amenorrhea (uh-men-o-REE-uh) is the absence of menstruation, often defined as missing one or more menstrual periods.
Primary amenorrhea refers to the absence of menstruation in someone who has not had a period by age 15. The most common causes of primary amenorrhea relate to hormone levels, although anatomical problems also can cause amenorrhea.
Secondary amenorrhea refers to the absence of three or more periods in a row by someone who has had periods in the past. Pregnancy is the most common cause of secondary amenorrhea, although problems with hormones also can cause secondary amenorrhea.
Treatment of amenorrhea depends on the underlying cause.
Depending on the cause of amenorrhea, you might experience other signs or symptoms along with the absence of periods, such as:
Consult your doctor if you've missed at least three menstrual periods in a row, or if you've never had a menstrual period and you're age 15 or older.
Amenorrhea can occur for a variety of reasons. Some are normal, while others may be a side effect of medication or a sign of a medical problem.
During the normal course of your life, you may experience amenorrhea for natural reasons, such as:
Some people who take birth control pills (oral contraceptives) may not have periods. Even after stopping birth control pills, it may take some time before regular ovulation and menstruation return. Contraceptives that are injected or implanted also may cause amenorrhea, as can some types of intrauterine devices.
Certain medications can cause menstrual periods to stop, including some types of:
Sometimes lifestyle factors contribute to amenorrhea, for instance:
Many types of medical problems can cause hormonal imbalance, including:
Problems with the sexual organs themselves also can cause amenorrhea. Examples include:
The ovaries, fallopian tubes, uterus, cervix and vagina (vaginal canal) make up the female reproductive system.
Factors that may increase your risk of amenorrhea include:
The causes of amenorrhea can cause other problems as well. These include:
During your appointment, your doctor will perform a pelvic exam to check for any problems with your reproductive organs. If you've never had a period, your doctor may examine your breasts and genitals to see if you're experiencing the normal changes of puberty.
Amenorrhea can be a sign of a complex set of hormonal problems. Finding the underlying cause can take time and may require more than one kind of testing.
A variety of blood tests may be necessary, including:
For this test, you take a hormonal medication for seven to 10 days to trigger menstrual bleeding. Results from this test can tell your doctor whether your periods have stopped due to a lack of estrogen.
Depending on your signs and symptoms — and the result of any blood tests you've had — your doctor might recommend one or more imaging tests, including:
If other testing reveals no specific cause, your doctor may recommend a hysteroscopy — a test in which a thin, lighted camera is passed through your vagina and cervix to look at the inside of your uterus.
Treatment depends on the underlying cause of your amenorrhea. In some cases, birth control pills or other hormone therapies can restart your menstrual cycles. Amenorrhea caused by thyroid or pituitary disorders may be treated with medications. If a tumor or structural blockage is causing the problem, surgery may be necessary.
Some lifestyle factors — such as too much exercise or too little food — can cause amenorrhea, so strive for balance in work, recreation and rest. Assess areas of stress and conflict in your life. If you can't decrease stress on your own, ask for help from family, friends or your doctor.
Be aware of changes in your menstrual cycle and check with your doctor if you have concerns. Keep a record of when your periods occur. Note the date your period starts, how long it lasts and any troublesome symptoms you experience.
Your first appointment will likely be with your primary care physician or gynecologist.
Here's some information to help you prepare for your appointment and know what to expect from your doctor.
To get ready for your appointment:
For amenorrhea, some basic questions to ask your doctor include:
Your doctor will likely ask you a few questions, such as: