Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at January 14, 2016

Amenorrhea is a medical term used to describe the absence of menstrual periods in a woman. Though normal among adult women during pregnancy and menopause, it can be pretty common outside of those states and most of the time does not suggest anything serious; however, longer periods of amenorrhea could be a sign of some other underlying conditions.


Definition & Facts

Amenorrhea may be a primary or secondary condition. Primary amenorrhea is used to describe a lack of menstruation and sexual characteristics, such as pubic hair and breast development, in females by the age of 14. It also describes the lack of menstruation despite the development of sexual characteristics in females by the age of 16.

Secondary amenorrhea is used to describe the loss of menstrual bleeding in a woman who has experienced menstruation previously. There are different reasons for why a woman would experience the absence of menstrual bleeding.

Symptoms & Complaints

The most obvious symptom of amenorrhea is an abnormal lack of menstrual bleeding that lasts for at least three consecutive cycles, or for longer than six months. There may be other accompanying symptoms, however, especially if there is an underlying condition that is causing the absence of menstruation. Some of these symptoms could include fatigue, nipple discharge, hair loss, pelvic pain or discomfort, increased acne, vision changes, headaches, and more. There could be other symptoms that occur along with amenorrhea, but this depends on what is causing the problem.


One of the most common causes of amenorrhea is pregnancy. A woman experiences menstrual bleeding when the lining of the uterus sheds. This is part of the menstrual cycle and occurs after an egg is released during ovulation and implants in the thickening uterine wall. When the woman does not get pregnant, the uterus sheds the lining, which results in menstrual bleeding. If a woman does get pregnant, her cycles then stop, and she experiences amenorrhea.

Menstrual cycles are regulated by hormones, and sometimes an imbalance can cause problems. Menopause can also make these cycles stop, and this can occur sooner in some women than others.

The hypothalamus, pituitary gland, ovaries, and uterus also need to all be functioning normally to have regular cycles. Issues in these areas can cause amenorrhea. In the hypothalamus, it can be caused by a tumor; a chronic disease called sarcoidosis, which forms nodules throughout the body; Kallman syndrome, which is a deficiency of the hormones that are responsible for reproductive organ growth and function; nutritional deficiency; and low body weight.

In the pituitary gland, amenorrhea can be caused by prolactinemia, which is high levels or the hormone prolactin, which stimulates milk production, or prolactinoma, which is a tumor of the pituitary gland. Other pituitary gland tumors such as Cushing's syndrome can cause a ceasing of menstrual bleeding.

Postpartum pituitary necrosis and autoimmune hypophysitis can also cause amenorrhea. Ovarian causes include anovulation, hyperandrogenemia, polycystic ovarian syndrome, intrauterine adhesion, galactose, and more.

Other possible causes of amenorrhea are excessive exercise, stress, thyroid malfunction, and structural abnormalities of the reproductive organs. Some cases of extreme anorexia nervosa can cause amenorrhea because of the lack of nutrition and low weight. Certain medications, as well as cancer treatments, can also cause the menstrual cycles to cease. There may also be a genetic factor; some women with a family history of amenorrhea may be more at risk.

Diagnosis & Tests

If a woman is experiencing a lack of menstrual bleeding, and is not pregnant or menopausal, it's important to see a doctor, specifically a gynecologist. The doctor will perform examinations and screening to determine if there is a specific cause.

Before the appointment, it's wise to compile a list of questions, as well as make sure to write down specific symptoms, dates of previous periods, family history, and other concerns. During these screenings, doctors will ask about certain lifestyle factors such as diet, exercise, sexual activity, use of birth control, and levels of stress.

Examinations may include pelvic exams and breast exams, as well as urine tests and blood tests to detect pregnancy or hormonal imbalances. They may also perform an ultrasound, MRI, CT scan or hysteroscopy. It may be necessary to see different specialists, in case there is some sort of condition that needs to be properly diagnosed in order to receive treatment.

Treatment & Therapy

There is not one single treatment for amenorrhea, since this is normally a symptom of something else. Treatment will depend on what exactly is causing the issues. If pregnant, menstrual cycles will resume after birth. If it is caused by something related to diet, nutritional deficiencies, or low weight, such as that which occurs with anorexia nervosa, then treatment will be focused on improving diet and perhaps therapy to address any psychological disorders. Psychotherapy may be beneficial for those with extreme stress that is causing the absence of menstrual bleeding.

If there are any tumors or abnormalities, this will be addressed and treated accordingly. Surgery may be needed in some cases. Hormone-related and other causes will also be treated accordingly, with medications or hormone replacement therapy if needed.

Prevention & Prophylaxis

Amenorrhea is not technically a harmful or remotely life-threatening condition, although in some cases, lack of menstruation can lead to estrogen dominance. However, this is easily treated. Since there is such a wide range of causes for this disorder, it's wise to just practice good lifestyle habits to maintain health.

Women should avoid smoking, excessive exercise, and strive to find coping mechanisms for life, so as to minimize stress; It's also important for women to track their cycles, so they can tell when there are any changes that may need to be addressed; start and end dates for periods should be recorded, as well as any questions or concerns.

Regular gynecological exams can also help keep women healthy, as well as detect any issues that may come up early on. Women should strive to eat whole, nutritious foods and seek help if they are suffering from any eating disorder. With diligence and awareness, amenorrhea does not have to be a problem for anyone, and may only occur if a woman becomes pregnant, or toward the end of her reproductive years.