What is amenorrhea?

If you don’t have your period for more than 3 cycles, it is called amenorrhea. It may be classified as primary or secondary:

• Primary amenorrhea. Menstruation never begins at puberty.
• Secondary amenorrhea. This type is due to some physical cause and usually of later onset. Your periods were at one time normal and regular but become increasingly abnormal and irregular or absent.

What causes amenorrhea?

There are several possible causes of amenorrhea, including:

• Pregnancy. When you are pregnant, you don’t ovulate so your period stops temporarily.
• Ovulation abnormality. Ovulation abnormalities are usually the cause of very irregular or frequently missed periods.
• Birth defect, anatomical abnormality, or other medical condition. If your period hasn’t started by age 16, it may be due to a birth defect, anatomical abnormality, or other medical condition.
• Eating disorder. If you have anorexia and/or bulimia, you may develop amenorrhea. This is because your body weight can get too low to sustain a pregnancy. So to protect the body, the reproductive system “shuts down” because it’s severely malnourished.
• Overexercise or strenuous exercise. If you exercise a lot, your periods may stop due to low body fat content.
• Thyroid disorder. If you have an underactive thyroid (hypothyroidism) or an overactive thyroid (hyperthyroidism) your periods may stop.
• Obesity. If you are overweight, you may have amenorrhea as a result of excess fat cells getting in the way of the process of ovulation.

What are the symptoms of amenorrhea?

If you don’t have your period for more than 3 cycles, it is called amenorrhea.

How is amenorrhea diagnosed?

Diagnosis begins with a medical history and a complete physical exam, including a pelvic exam. Your healthcare provider will want to rule out other menstrual disorders, medical conditions, or medicines that may be causing or aggravating the condition. A diagnosis of amenorrhea means that you miss at least 3 periods in a row, without being pregnant. Young women who haven’t had their first menstrual period by age 15 should be evaluated promptly. Making an early diagnosis and starting treatment as soon as possible is very important.

How is amenorrhea treated?

Your healthcare provider will figure out the best treatment for you based on:

• How old you are
• Your overall health and past health
• How sick you are
• How well you can handle specific medicines, procedures, or therapies
• How long the condition is expected to last
• Your opinion or preference

Treatment for amenorrhea may include:

• Hormone treatment (progesterone supplements)
• Oral birth control pills (prevents ovulation)
• Dietary changes to include increased caloric and fat intake
• Calcium supplements to reduce bone loss

Key points

• Amenorrhea is characterized by missing your period 3 cycles in a row.
• Primary amenorrhea means a girl doesn’t start menstruating when she reaches puberty.
• Secondary amenorrhea means your periods were normal, but have stopped due to an underlying condition.
• Treatment of amenorrhea depends on the cause but may include hormones, birth control pills, or dietary changes.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

• Know the reason for your visit and what you want to happen.
• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your healthcare provider tells you.
• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
• Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
• Ask if your condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if you don’t take the medicine or have the test or procedure.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.