Obstetrics and Gynecology

Amenorrhea

Amenorrhea, also known as missed periods, is the absence of a normal monthly period or menstrual cycle.

There are two types of amenorrhea:

  • Primary amenorrhea. When a young woman has not had her first period by age 16.
  • Secondary amenorrhea. When a woman who was previously menstruating stops having periods for three months or more. This is the most common type of amenorrhea.

What causes amenorrhea?

In addition to normal conditions such as pregnancy or menopause, amenorrhea can be caused by a number of changes in the organs, glands, and hormones involved in menstruation.

For primary amenorrhea, possible causes include:

  • Failure of the ovaries
  • Problems in the nervous system or the pituitary gland
  • Poorly formed reproductive organs
  • Sudden or extreme weight gain or loss
  • Long-term illness
  • Extreme exercise

For secondary amenorrhea, possible causes include:

A-O

  • Breastfeeding
  • Certain drugs
  • Depression
  • Extreme weight loss or gain
  • Menopause
  • Obesity
  • Ongoing illness
  • Over-exercising

P-Z

  • Poor nutrition
  • Pregnancy
  • Problems with hormone-making glands, including the thyroid (rare)
  • Some birth control methods
  • Stopping the use of birth control pills
  • Stress
  • Tumors on the ovaries (rare)

How is amenorrhea diagnosed?

The first step in diagnosis is to determine if you are not having periods because of a normal condition such as pregnancy or menopause. Your doctor will ask about your medical history, including changes in your menstrual cycle, diet, exercise, medications, and emotional stress.

Determining the underlying cause of amenorrhea may involve a series of tests, including:

  • Pregnancy test
  • Pelvic exam
  • Physical exam
  • Blood tests
  • Progestin challenge test (to check for lack of estrogen)
  • Imaging tests
  • Laparoscopy or hysteroscopy, to view internal organs

How is amenorrhea treated?

Treatment for amenorrhea will depend on the cause, and may include lifestyle changes and medical treatment, including:

  • Dieting and exercise to lose or gain weight
  • Stress management
  • A change in physical activity levels
  • Hormone therapy or other medications
  • Surgery, in rare cases

How can I prevent amenorrhea?

Secondary amenorrhea can be prevented in some cases through a healthy, balanced lifestyle. Preventative steps include:

  • Maintain a healthy weight
  • Maintain a healthy balance in work, recreation and sleep
  • Get annual pelvic exams and Pap smears
  • Manage stress levels