Amenorrhea

What is amenorrhea?

Amenorrhea is when you don’t get your menstrual period. There are two kinds of amenorrhea: primary and secondary. Primary amenorrhea is when a person older than 15 has never gotten their first period. Secondary amenorrhea happens when a person doesn’t get a period for more than three months.

How does menstruation work?

A complex system of hormones controls your menstrual cycle. Every cycle, these hormones prepare your uterus for a possible pregnancy. If there’s no pregnancy that cycle, you shed your uterine lining. That shedding is your period. There are many factors that can affect your period including issues with the following organs and structures:

• Hypothalamus: Controls your pituitary gland, which affects ovulation (releasing an egg).
• Ovaries: Store and produce the egg for ovulation and the hormones estrogen and progesterone.
• Uterus: Responds to the hormones by thickening your uterine lining. This lining sheds as your menstrual period if there’s no pregnancy.

What are the types of amenorrhea?

Primary amenorrhea

Primary amenorrhea is when you haven’t gotten your first period by age 15 or within five years of the first signs of puberty (such as developing breasts). It’s usually due to genetic conditions (conditions you’re born with) or acquired abnormalities (conditions that develop after birth).

Secondary amenorrhea

Secondary amenorrhea is when you’ve been getting regular periods, but you stop getting your period for at least three months, or your period stops for six months when they were previously irregular. Common reasons for this type of amenorrhea include:

• Pregnancy.
• Lactation.
• Stress.
• Having a chronic illness.

How common is amenorrhea?

About 1 in 4 women and people assigned female at birth who aren’t pregnant, breastfeeding or going through menopause experience amenorrhea at some point in their lives.

What are the symptoms of amenorrhea?

The main symptom is the lack of periods. Other symptoms depend on the cause. You may experience:

• Hot flashes.
• Nipples leaking milk.
• Vaginal dryness.
• Headaches.
• Vision changes.
• Acne.
• Excess hair growth on your face and body.

How do you get amenorrhea?

The different types of amenorrhea have different causes. Some causes happen naturally on their own, while others may be a sign of a medical condition or problem.

Natural (or normal) reasons to miss your period include:

• Pregnancy (the most common cause of secondary amenorrhea).
• Breastfeeding (or lactation amenorrhea).
• Menopause.
• Having surgery to remove your uterus or ovaries.

Common causes of primary amenorrhea

Primary amenorrhea occurs when you haven’t had a period by 15 years old. Common causes include:

• Chromosomal or genetic problems that affect your reproductive system, such as Turner syndrome.
• Hormonal issues stemming from problems with your brain or pituitary gland.
• Structural problem with your organs, such as missing parts of your uterus or vagina or having an underdeveloped reproductive system.

Common causes of secondary amenorrhea

Secondary amenorrhea is when you miss your period for three or more months after previously having a normal period. Common causes include:

• Some birth control methods, such as Depo-Provera®, intrauterine devices (IUDs) and certain birth control pills.
• Chemotherapy and radiation therapy for cancer.
• Previous uterine surgery with scarring (for example, if you had a dilation and curettage, often called D&C).
• Stress.
• Poor nutrition.
• Weight changes — extreme weight loss or gain.
• Extreme exercise routines.
• Certain medications.

The following medical conditions may also cause secondary amenorrhea:

• Primary ovarian insufficiency (POI), when your ovaries stop working before age 40.
• Hypothalamic amenorrhea, a condition where amenorrhea occurs due to an issue with your hypothalamus.
• Pituitary disorders, such as a benign pituitary tumor or excessive production of prolactin.
• Hormonal imbalances as a result of conditions like polycystic ovary syndrome, adrenal disorders or hypothyroidism.
• Ovarian tumors.
• Obesity.
• Ongoing illness or chronic illness (like kidney disease or inflammatory bowel disease).

What are risk factors for amenorrhea?

Risk factors for amenorrhea include:

• Family history of amenorrhea or early menopause.
• Genetic or chromosomal condition that affects your ovaries or uterus.
• Obesity or being underweight.
• Eating disorder.
• Over-exercising.
• Poor diet.
• Stress.
• Chronic illness.

Are there complications of amenorrhea?

Amenorrhea isn’t life-threatening. However, some causes can lead to long-term complications, so amenorrhea should always be evaluated by a healthcare provider. Having amenorrhea may make you more likely to develop:

• Osteoporosis or cardiovascular disease (due to a lack of estrogen).
• Difficulties getting pregnant or infertility.
• Pelvic pain (if structural issues are the cause).

How is amenorrhea diagnosed?

Contact a healthcare provider if you miss a period. They’ll ask you about your symptoms and medical history, including your menstrual history. Your provider will perform a physical exam and a pelvic exam.

How do healthcare providers test for amenorrhea?

Your healthcare provider may want to do some tests, including:

• Pregnancy test.
• Blood tests to check your hormone levels and detect thyroid or adrenal gland disorders.
• Genetic testing, if you have primary ovarian insufficiency and are younger than 40.
• MRI, if your provider suspects a problem with your pituitary gland.
• Ultrasound, if your provider suspects an issue with your ovaries or uterus.

Should I keep track of my periods?

Diagnosing amenorrhea can be challenging. If the cause of amenorrhea isn’t obvious, such as pregnancy or menopause, your provider may ask you to keep a record of changes in your menstrual cycle. This history of your periods can help your provider figure out a diagnosis.

Using an app or a journal, note:

• How long your periods last.
• When you had your last period.
• Medications you’re taking.
• Changes in your diet or exercise routine.
• Emotional challenges you’re having, such as stress.

How is amenorrhea treated?

If your period stopped because of menopause, lactation or pregnancy, your provider won’t need to treat it.

In other cases, your treatment will depend on the cause and may include:

• Following a diet and exercise plan that help you maintain a weight that’s healthy for you.
• Stress management techniques.
• Changing exercise levels.
• Hormonal treatment (medication), as prescribed by your healthcare provider.
• Surgery (in rare cases).

In addition, your healthcare provider may recommend some treatments to help with the side effects of amenorrhea:

• Estrogen therapy to relieve hot flashes and vaginal dryness.
• Calcium and vitamin D supplements to keep bones strong.
• Strength training (lifting weights or doing movements to strengthen your muscles).

Will I need surgery for amenorrhea?

Surgery for amenorrhea is rare. Your healthcare provider may recommend it if you have:

• A physical difference that prevents vaginal bleeding like a vaginal septum or imperforate hymen.
• Pituitary tumor.
• Uterine scar tissue.

How long does amenorrhea last?

Most cases of amenorrhea are treatable. With treatment, your periods should start to happen regularly. It can take a few months for your periods to come back, but in most cases, they will. Talk to your healthcare provider about what you can expect with treatment.

How can I prevent amenorrhea?

Maintaining good overall health can help prevent some causes of secondary amenorrhea. Try to:

• Follow a diet and exercise plan that’s healthy for you.
• Be aware of your menstrual cycle (so you’ll know if you miss a period).
• Get regular gynecological appointments, including having a pelvic exam and Pap test.
• Get regular and adequate sleep.

Will my period return?

Typically, your period will return once you treat the underlying cause. However, it may take time to become regular again.

In some cases, you may have a health problem that means you’ll never have a period. If that’s the case, your provider can talk to you about fertility options if you wish to become pregnant.

When should I see my healthcare provider about amenorrhea?

You should call your healthcare provider if you miss three months of periods. Visit your provider if you miss a period and:

• Have trouble with balance, coordination or vision (these symptoms might indicate a more serious condition).
• Produce breast milk when you haven’t given birth.
• Notice excessive body hair growth.
• Are older than 15 and haven’t gotten your first period yet.

What else should I ask my healthcare provider?

When you talk to your healthcare provider, ask:

• What’s causing my amenorrhea?
• What are my treatment options, and what are the risks and benefits to each?
• Do I need to see an endocrinologist for hormonal treatments?
• Can I still get pregnant if I have amenorrhea?
• Once my period returns, can I get amenorrhea again?

Is it normal to have amenorrhea after stopping the pill?

Yes, some people notice they don’t get their period after stopping birth control pills (post-pill amenorrhea). This is because your body is trying to remember how to produce the hormones necessary for ovulation and menstruation. It can take up to three months for your body to resume menstruation. Talk to your healthcare provider if you go longer than four to six months without a period after stopping the pill.

Is amenorrhea a type of infertility?

No, amenorrhea isn’t a form of infertility. However, not getting a menstrual period can lead to not being able to get pregnant. If having a child is your goal and your menstrual cycle is irregular or absent, contact your healthcare provider for an appointment.

A note from Cleveland Clinic

Talk to your healthcare provider if you’re older than 15 and haven’t gotten your period or you’ve had a normal menstrual cycle but now you’re missing periods. Amenorrhea is usually the sign of a treatable condition. Once your provider figures out what’s causing missed periods, you can get care to regulate your cycle. You may need lifestyle changes or hormonal treatment to help resume normal menstrual cycles.