Amenorrhea

Causes of Amenorrhea

There are many possible causes of amenorrhea, some of which are normal or temporary. These include natural amenorrhea that occurs with pregnancy, breastfeeding and menopause. Other causes of amenorrhea include hormone imbalances, structural abnormalities and lifestyle factors.

Reasons your period may stop include:

• Contraceptives: Certain types of contraception, including some oral birth control pills and implanted contraceptives, may cause your period to stop. After you stop taking the pills and/or remove the implant, it could take up to several months for normal ovulation and menstruation to resume.
• Hypothalamic amenorrhea: This occurs when the hypothalamus gland in the brain slows or stops releasing the gonadotropin-releasing hormone (GnRH), which starts the menstrual cycle.
• Hyperprolactinemia: Higher levels of the hormone prolactin can cause problems with menstruation. High prolactin levels can be caused by things such as certain medications (such as birth control or antipsychotic drugs), pituitary tumors or hypothyroidism.
• Lifestyle factors: Very low body weight, excessive exercise and high stress levels can all influence hormone levels, which can lead to interrupted menstrual cycles.
• Medications: Amenorrhea can be a side effect when taking certain medications. These can include antidepressants, blood pressure medications, allergy medications and chemotherapy.
• Pituitary tumors: Non-cancerous tumors of the pituitary gland, which regulates production of hormones that affect metabolism and the reproductive cycle, can interfere with menstruation.
• Polycystic ovary syndrome (PCOS): This condition causes a hormone imbalance which can cause menstrual periods to become irregular or absent.
• Primary ovarian insufficiency: The loss of normal function of your ovaries before age 40 can lead to early menopause.
• Thyroid problems: A thyroid gland that is either overactive (hypothyroidism) or underactive (hypothyroidism) can affect hormone levels and cause amenorrhea.
• Underdeveloped reproductive system: Problems during fetal development can lead to missing reproductive organs, such as the uterus, cervix or ovaries. This can affect the ability to menstruate later in life.
• Uterine scarring: Scar tissue that develops in the uterus after a surgical procedure could interfere with the normal buildup and shedding of the uterine lining every cycle.

Amenorrhea Risk Factors

Women with the following risk factors have a higher risk of amenorrhea:

• Family history of amenorrhea or early menopause.
• Eating disorders such as anorexia or bulimia.
• Obesity.
• Rigorous athletic training.
• History of gynecologic procedures such as dilation and curettage (D&C), C-section or fibroid surgery.

Other Symptoms

While the lack of periods is the most common symptoms of amenorrhea, other symptoms may include:

• Hair loss
• Headache
• Hirsutism (excess body hair)
• Lack of breast development
• Milky discharge from the breasts
• Ovulation problems
• Vision changes

Complications from amenorrhea can include:

• Infertility
• Heart disease
• Miscarriage and other pregnancy problems
• Osteoporosis
• Pelvic pain
• Stress

Diagnosing Amenorrhea

You should seek medical care for lack of menstruation if you:

• Have not had a period for three months in a row.
• Haven’t had your first period by age 15.

Your provider will perform a physical exam, including a pelvic exam, as well as take a personal medical history and discuss any other symptoms you are experiencing. To help determine the cause of amenorrhea, your provider may also order other tests, including:

• Pregnancy test.
• Imaging tests, such as magnetic resonance imaging (MRI), computed tomography (CT) and ultrasound of the pelvic area to look for abnormalities.
• Blood tests to measure levels of hormones such as prolactin and follicle stimulating hormones. Unbalanced levels of these hormones can disrupt the menstrual cycle.
• Hysteroscopy: A procedure in which a thin tube with a camera is passed through the vagina and cervix to examine the uterus.
• Genetic screening: This can look for certain gene anomalies and genetic conditions that may contribute to amenorrhea.

Amenorrhea Treatment

Treatment focuses on addressing the underlying cause of amenorrhea. Depending on the specific condition, there are a wide variety of treatment options including lifestyle changes, medications and surgery.

Depending on test results, a girl with primary amenorrhea may be recommended watchful waiting, with follow-up visits every three to six months to check if menstruation has started. Other primary amenorrhea treatments can include hormone therapy and surgery to correct anatomical problems.

Common treatments for secondary amenorrhea include:

• Birth control pills to regulate the menstrual cycle.
• Medications to help trigger ovulation.
• Estrogen replacement therapy to balance hormone levels and restart menstruation.
• Dietary supplements such as calcium and vitamin D.
• Changes in diet and exercise habits in order to achieve a healthy weight.
• Stress management.