What is amenorrhea?

Amenorrhea is when you don’t get your monthly period. It can be temporary or permanent. Amenorrhea can result from a change in function or a problem with some part of the female reproductive system.

There are times when you’re not supposed to get your period, such as before puberty, during pregnancy and after menopause. If amenorrhea lasts for more than three months, it should be investigated.

How does the menstrual cycle work?

A complex system of hormones controls the menstrual cycle. Every month, hormones prepare the body for pregnancy. Ovulation then occurs. If there is no pregnancy, the cycle ends with the uterus shedding its lining. That shedding is the menstrual period.

The hormones responsible for this cycle originate in different parts of the body. A dysfunction in any of these parts can prevent a person from getting a period:

  • Hypothalamus, which controls the pituitary gland.
  • Pituitary gland, called “the master gland,” which produces the hormones that instruct the ovaries to ovulate.
  • Ovaries, which produce the egg for ovulation and the hormones estrogen and progesterone.
  • Uterus, which responds to the hormones and prepares the lining. This lining sheds as the menstrual period if there’s no pregnancy.

What are the types of amenorrhea?

There are two classifications of amenorrhea:

  • Primary amenorrhea is when you haven’t gotten a first period by age 15 or within five years of the first signs of puberty. It can happen due to changes in organs, glands and hormones related to menstruation.
  • Secondary amenorrhea is when you’ve been getting regular periods, but you stop getting your period for at least three months, or you stop your menses for six months when they were previously irregular. Causes can include pregnancy, stress and illness.

Who is at risk for amenorrhea?

Risk factors for amenorrhea include:

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

What causes amenorrhea?

The different types of amenorrhea have different causes.

Common causes of primary amenorrhea include:

  • Chromosomal or genetic problem with the ovaries (the female sex organs that hold the eggs).
  • Hormonal issues stemming from problems with the hypothalamus or the pituitary gland.
  • Structural problem with the reproductive organs, such as missing parts of the reproductive system.

Common causes of secondary amenorrhea include:

Other causes of secondary amenorrhea can include:

  • Stress.
  • Poor nutrition.
  • Weight changes — extreme weight loss or obesity.
  • Exercising associated with low weight.
  • Ongoing illness or chronic illness.

You may also have conditions that can cause secondary amenorrhea:

  • Primary ovarian insufficiency, when you experience menopause before age 40.
  • Hypothalamus disorders, such as functional hypothalamic amenorrhea (FHA) — which is also called hypothalamic amenorrhea (HA). FHA is a condition where amenorrhea is associated with stress or weight loss, but isn’t clearly caused by an organic issue with a woman’s body.
  • Pituitary disorders, such as a benign pituitary tumor or excessive production of prolactin.
  • Other hormonal problems, such as polycystic ovary syndrome, adrenal disorders or hypothyroidism.
  • Ovarian tumors.
  • Surgery to remove uterus or ovaries.

What are the symptoms of amenorrhea?

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

Last reviewed by a Cleveland Clinic medical professional on 09/30/2020.

References

  • Hormone Health Network. Amenorrhea. Accessed 10/20/2020.
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development. Amenorrhea. Accessed 10/20/2020.
  • American Academy of Family Physicians. Amenorrhea. Accessed 10/20/2020.

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