What is Amenorrhea?

Amenorrhea is the absence of menstruation for one or more cycles, or absence of menstruation for teenagers past 15 years of age. Most often, the cause of amenorrhea is pregnancy, but there are other less common causes that can be explored if pregnancy is ruled out. These causes can be grouped depending on their origin

  • Natural causes: Pregnancy, breast-feeding, and menopause are natural things in the course of a woman’s life that can lead to amenorrhea
  • Contraceptive use: Some types of birth control pills or injected/implanted birth control options can lead to amenorrhea. In addition, when stopping one of these methods, it may take several months for the body to re-establish a regular cycle again.
  • Medications: Certain medications can cause amenorrhea, including antipsychotics, chemotherapy, antidepressants, blood pressure medications, and allergy medications
  • Lifestyle factors: Excessively low body weight, excessive exercise, and stress can lead to changes in the hormonal functions in your body which can halt ovulation or menstruation
  • Hormonal Imbalance: Medical problems such as polycystic ovary syndrome, thyroid malfunction, pituitary tumors, or premature menopause can lead to interruptions in hormonal balance and thus menstruation
  • Structural problems: Uterine scarring or structural differences at birth with the reproductive system can lead to amenorrhea

Other Possible Symptoms

  • Milky nipple discharge
  • Hair loss
  • Headache
  • Vision changes
  • Excess facial hair
  • Pelvic pain
  • Acne

When Should I Go to the Doctor?

If you have missed more than one cycle or have not begun to menstruate (and are 15+ years old) you should discuss your symptoms with a healthcare provider. In preparation for a visit for amenorrhea, it is important to provide some details about your history such as the last time you menstruated, how long/heavy that cycle was, medical history, and family history (did mother/sister have similar symptoms?). Depending on the cause for amenorrhea, other symptoms may be present as listed in the text box. These will be important to the healthcare provider in determining the cause.

What Will My Healthcare Provider Do?

Your healthcare provider will ask a number of health history questions as well as perform a variety of blood tests. These tests may include pregnancy test, thyroid function test, ovarian function test, prolactin test, and hormone test. A pelvic exam may also be performed to determine the level of normal puberty changes. In some cases, image tests may be recommended (ultrasound, CT, or MRI scanning) to take a closer look at reproductive anatomy.

What Are Possible Treatments?

Treatment will depend to the cause of the amenorrhea. In some cases, medication can be used to regulate hormones (birth control pills) or treat thyroid/pituitary problems. In other cases, lifestyle changes may be all that’s recommended in an effort to balance diet, exercise, and stress to a healthier level. Appropriate treatments will be recommended by your healthcare provider so don’t hesitate to contact us for an appointment.

More Info

Mayo Clinic Amenorrhea