Amenorrhea

Amenorrhea

What is amenorrhea?

Amenorrhea is when you don’t have menstrual periods. There are two types of amenorrhea. Primary amenorrhea is when you are late to start your period for the first time. The normal age range is 14 to 16 years old. Secondary amenorrhea is when you miss a period for 3 months in a row or more.

Symptoms of amenorrhea

The main symptom of amenorrhea is the absence of your monthly period. It often signifies a larger health problem or condition. Related symptoms can include:

  • headache
  • vision changes
  • nausea
  • extra facial hair
  • hair loss
  • changes in breast size
  • milky fluid, or discharge, from breasts.

What causes amenorrhea?

The main causes of primary amenorrhea include family history, genetics, and lifestyle. Women with the following factors are more at risk:

  • a family history of amenorrhea or early menopause
  • a genetic or chromosomal defect. These can affect your ovary function and menstrual cycle. Turner syndrome is one example.
  • severely over or under weight
  • an eating disorder
  • an extreme exercise pattern
  • a poor diet
  • stress.

Pregnancy, breastfeeding, and menopause can cause secondary amenorrhea. Other possible causes include:

  • some birth controls, such as pills, injections, or intrauterine devices. These can affect your menstrual cycle during and after use.
  • some medicines for depression and blood pressure
  • chemotherapy and radiation treatment
  • polycystic ovary syndrome (PCOS)
  • fragile X syndrome (caused by the FMR1 gene) or fragile X-associated primary ovarian insufficiency (FXPOI)
  • problems with your thyroid or pituitary gland
  • hypothalamic disease
  • uterine scar tissue.

How is amenorrhea diagnosed?

Contact your family doctor or a gynecologist if you think you have amenorrhea. If you’ve never menstruated, the doctor will review your health history and do an exam. A regular physical and pelvic check can show signs of puberty.

For secondary amenorrhea, the doctor will begin with a pregnancy test. If this is negative, then they will do an exam and review your health history.

Additional tests may be needed to help rule out or determine a cause. A karyotype test looks at your chromosomes. A genetic test looks for the mutated FMR1 gene. Imaging tests can look at your female organs. A blood test can check your:

  • thyroid function (thyroid-stimulating hormone, or TSH, levels)
  • ovary function (follicle-stimulating hormone, or FSH, and luteinizing hormone, or LH, levels)
  • testosterone (“male hormone”) levels, which can detect PCOS
  • estrogen (“female hormone”) levels.

Can amenorrhea be prevented or avoided?

It is hard to prevent amenorrhea. Try to maintain a healthy diet and exercise plan. If you are under- or overweight, talk to your doctor about how to find a balance. Once you begin to menstruate, keep track of your periods each month. This can help identify amenorrhea early on and aid in your diagnosis and treatment. It also is good practice if you try to become pregnant in the future.

Amenorrhea treatment

Treatment options for amenorrhea vary based on the cause. You may need to make lifestyle changes, such as diet, activity, and stress. Certain hormonal medicines and birth control pills can help trigger a period. Others can help trigger ovulation, such as for PCOS. Hormone therapy may be used to balance out your hormones.

Surgery is not common, but may be needed in some cases, such as:

  • to correct genetic or chromosomal defects
  • to remove a pituitary (brain) tumor
  • to remove uterine scar tissue.

Living with amenorrhea

For most women, their monthly periods return following treatment. In some cases, your related health problem may mean you never have a period. Depending on your underlying cause, you may struggle with fertility.

Questions to ask your doctor

  • If I have amenorrhea, can I still get pregnant?
  • What are the benefits, risks, and side effects of treatment?
  • If I have amenorrhea, will I always have it or can I get it again?