What is amenorrhea?

Amenorrhea is the absence of a monthly period. Women normally do not menstruate before puberty, during pregnancy, and after menopause. If amenorrhea happens at other times, it may be the symptom of a treatable medical condition.

There are two types of amenorrhea: primary amenorrhea and secondary amenorrhea. Primary amenorrhea is the absence of a first period in a young woman by the age of 16. Secondary amenorrhea is when a woman who has had normal menstrual cycles stops getting her monthly period.

What causes amenorrhea?

Amenorrhea can be caused by any number of changes in the organs, glands, and hormones involved in menstruation.

Primary amenorrhea

• failure of the ovaries (female sex organs that hold eggs)
• problems with hormones secreted by the hypothalamus or the pituitary gland (areas in the brain that make hormones involved in menstruation
• poorly formed reproductive organs

In many cases, the cause of primary amenorrhea is not known.

Secondary amenorrhea

Common causes of secondary amenorrhea are:

• pregnancy
• breast feeding
• no longer taking birth control pills
• menopause
• some birth control methods, such as Depo Provera

Other causes of secondary amenorrhea include:

• stress
• poor nutrition
• depression
• certain drugs/medications
• extreme weight loss
• over-exercising
• ongoing illness
• sudden weight gain or being very overweight (obesity)
• problems with hormone-making glands, including the thyroid (rare)
• tumors on the ovaries (rare)
• earlier uterine surgery with scarring

A woman who has had her uterus or ovaries removed will also stop menstruating.

How can I know if I have amenorrhea?

If you miss your period, contact your health care provider. First, he or she will want to know if your period has stopped because of a normal condition such as pregnancy or menopause. (Most women go through menopause in their early 50s.) You will be given a physical and pelvic exam, and will be asked about your medical history. You will also be asked to describe your symptoms. A sample of blood and urine may be taken for testing.

In some cases, finding the cause of amenorrhea can be difficult. You can help your health care provider by keeping a record of changes in your menstrual cycle with a menstrual calendar. Note how long your periods last and when you had your last period. Also, report any drugs you are taking and changes in your diet and/or exercise program. You should also report any emotional problems you are having, including stress.

How is amenorrhea treated?

Amenorrhea due to normal causes, such as pregnancy, does not need to be treated. In other cases, treatments will depend on the cause. Treatments include:

• dieting and exercising to lose weight (for amenorrhea caused by obesity)
• dieting to gain weight (for amenorrhea caused by extreme weight loss)
• learning ways to manage stress
• changing exercise levels
• hormones, ordered by a health care provider
• surgery (rarely)

Amenorrhea may be the symptom of anorexia nervosa, a serious eating disorder. If you or someone you care about has this condition, get help right away

When should I see my health care provider?

See your health care provider if you:

• miss a period
• have trouble with your balance, coordination, or vision
• begin producing breast milk, although you have not given birth
• have excessive body hair growth
• are over age 16 and haven't had your first period

How can I prevent secondary amenorrhea?

The best way to prevent secondary amenorrhea is to maintain a healthy lifestyle. Stay at a healthy weight, stay aware of your monthly period, and stay up to date with your scheduled pelvic exam and Pap smears.