What is amenorrhea?
After puberty and before menopause, menstruation should be a regular occurrence for women without any underlying health conditions. The hypothalamus and pituitary gland in the brain, which send and produce hormones, regulate this process along with the uterus and ovaries. Irregular menstrual cycles can be a marker of both physical and mental health.
A lack of regular menstrual cycles is known as amenorrhea. The condition can be difficult to diagnose and address because it has so many causes.
Experts estimate that, when not linked to breastfeeding or menopause, amenorrhea is present in between 3% and 4% of adult women. Sometimes the condition is not cause for concern. Often, however, it accompanies major health problems that should be promptly addressed.
Signs and symptoms of amenorrhea
The loss of menstruation can be considered a symptom in and of itself. But sometimes, symptoms may begin even before women with amenorrhea are aware that their menstrual cycle has changed. These symptoms include:
Breast milk secretions
While lactation can prompt amenorrhea, some women who are not breastfeeding still experience milk discharge. Also known as galactorrhea, this symptom often accompanies amenorrhea but can be a sign of several other medical conditions.
The hormone imbalances associated with amenorrhea may lead to the development of facial hair, a condition known as hirsutism. Some women may also experience excess body hair.
As with facial hair, increased acne may occur in response to the hormonal changes that take place while experiencing amenorrhea.
Types of amenorrhea
Primary amenorrhea is when young women have not experienced their first period by the age of 16. In such situations, amenorrhea may also be referred to as delayed menarche, or delayed puberty.
In secondary amenorrhea, women who have already established a regular menstrual cycle miss menstruation three times in a row or more. This sometimes involves a dysfunction of the hypothalamus. If the production of hormones required to trigger ovulation ends, the menstrual cycle becomes unnecessary and may stop altogether. Some medical professionals refer to this version of the condition as hypothalamic amenorrhea
Causes of amenorrhea
While pregnancy is often responsible for amenorrhea, the condition can occur for a wide variety of other reasons. Some of these are of little concern, but others may point to urgent issues with mental or physical health. A few of the most common causes of amenorrhea include:
Timing for the return of menstruation can differ dramatically based on whether women breastfeed, and to what extent. Exclusive breastfeeding may delay menstrual cycles by several months or even a year or more.
Known as lactational amenorrhea, this phenomenon sometimes involves family planning. Research suggests that the effectiveness of the lactational amenorrhea method (LAM) is limited, though that may be because of how difficult it can be to implement correctly.
Certain types of contraception limit menstruation or cause it to stop altogether. This response is most common for oral forms hormonal contraception, although some women with hormonal IUDs may also experience irregular periods or the full loss of menstruation.
Ovulation and menstruation become more irregular with the beginning of menopause, eventually giving way to the loss of menstrual periods altogether. This transition can vary significantly between women. Some experience amenorrhea sooner than expected due to premature menopause.
Sudden weight loss
In some cases, the loss of menstruation may be accompanied by sudden and significant weight loss. Some extreme athletes, for example, experience amenorrhea during times of intense training. Additionally, the loss of menstrual cycles is associated with eating disorders such as anorexia nervosa. Weight loss due to health concerns, such as cancer or type 1 diabetes, may also affect menstruation.
Some structural issues related to the reproductive system can contribute to amenorrhea. With Asherman's syndrome, for example, the buildup of scar tissue limits the buildup of the uterine lining required for menstruation.
Doctors often diagnose amenorrhea by inquiring about women's menstrual cycles. If these have not arrived by the age of 16—or if they have disappeared for three months or more—the condition may be diagnosed. Doctors also consider the influence of breastfeeding, contraception, or menopause, and they always rule out pregnancy first. A pelvic exam may follow after questions about these and other factors.
Treatments for amenorrhea
Preferred treatment for amenorrhea depends on the cause. The condition doesn’t always spark concern. Even when it does, treatments may focus on underlying factors rather than addressing the menstrual cycle itself. Some cases, however, may need swift treatment to avoid the long-term consequences of estrogen deficiency — low levels of the female hormone — that often accompanies amenorrhea.
When amenorrhea occurs due to genetic abnormalities, it can be treated with supplemental hormones. Cases involving structural issues of the reproductive system may require surgery.
American Family Physician: "Diagnosis and Management of Galactorrhea."
Cochrane Database of Systematic Reviews: "Lactational amenorrhea method for family planning."
Diabetes Care: "Menstrual Cycle Differences Between Women with Type 1 Diabetes and Women Without Diabetes."
Einstein (São Paulo): "Menstruation disorders in adolescents with eating disorders — target body mass index percentiles for their resolution."
Eunice Kennedy Shriver National Institute of Child Health and Human Development: "What causes amenorrhea?"
Fertility and Sterility: "Comprehensive Management of Severe Asherman Syndrome and Amenorrhea."
Harvard Health Publishing: "Amenorrhea."
The North American Menopause Society: "Chapter 1: Menopause."
The Practice Committee of the American Society for Reproductive Medicine: "Current Evaluation of Amenorrhea."
StatPearls: "Primary Amenorrhea."
Top What Can Cause Amenorrhea Other Than Pregnancy Related Articles
Cramps But No PeriodHaving cramps but no period can occur because of conditions other than your monthly menstrual cycle. They may feel like period cramps of the lower abdomen when you are not due for your period and produce no blood. These 12 diseases and conditions are examples of what can cause abdominal cramping when not on period.
How Can I Stop Prolonged Periods Naturally?Heavy periods may be a sign of some underlying health condition. Quite often, heavy and prolonged periods may be a result of nutritional deficiencies. There are a few home remedies for a heavy period. Your doctor may use medication or surgery to treat heavy periods.
How Many Days Before a Period Do You Get Discharge?Vaginal discharge is a normal part of a woman's menstrual cycle. Learn about vaginal discharge before a period, how many days you get discharge before your period, signs and causes of vaginal discharge, and when to see a doctor if there's a problem. Vaginal discharge is the fluid secreted from the uterus, cervix (neck of the uterus) and vagina. A thick yellow vaginal discharge may point to vaginitis (infection of the vagina).
Menstrual cramps (pain in the belly and pelvic area) are experienced by women as a result of menses. Menstrual cramps are not the same as premenstrual syndrome (PMS). Menstrual cramps are common, and may be accompanied by headache, nausea, vomiting, constipation, or diarrhea. Severity of menstrual cramp pain varies from woman to woman. Treatment includes OTC or prescription pain relief medication.
What Are Polycystic Ovarian Syndrome (PCOS) Symptoms?Polycystic ovarian syndrome (PCOS), also known by the name Stein-Leventhal syndrome, is a hormonal problem that causes women to have a variety of symptoms including irregular or no menstrual periods, acne, obesity, and excess hair growth. Treatment of PCOS depends partially on the woman's stage of life and the symptoms of PCOS.
Premenstrual Dysphoric Disorder (PMDD)Premenstrual dysphoric disorder (PMDD) is considered a severe form of premenstrual syndrome (PMS). PMDD has also been referred to as late luteal phase dysphoric disorder. The cause of PMDD is unknown. Some of the common symptoms of PMDD (not an inclusive list) include mood swings, bloating, fatigue, headache, irritability, headache, breast tenderness, acne, and hot flashes. Treatment for PMDD is with medication to treat the symptoms of PMDD.
Premenstrual Dysphoric Disorder PMDD QuizPremenstrual dysphoric disorder (PMDD) can be serious and debilitating for some women. The good news is that women do not have to suffer. Take this quiz to learn the differences between PMDD symptoms and its milder cousin, premenstrual syndrome (PMS).
PMS SlideshowPremenstrual Syndrome (PMS) can cause from mood swings, munchies, and more. Learn about the symptoms, causes and treatments of PMS.
25 Ways to Relieve Menstrual CrampsMenstrual cramps happen when prostaglandins force the uterus to contract. Dysmenorrhea, or period pain, may be relieved by heating pads, ibuprofen, and other measures. Endometriosis may cause severe cramps during the menstrual cycle. Luckily, women have many options for period pain relief.
What Are the Side Effects of Having Irregular Periods?Having irregular periods is a common issue that affects many women. Learn the side effects of having irregular periods, the symptoms of irregular periods, what causes irregular periods, how doctors diagnose irregular periods, and what you can do to treat irregular periods.
What Are Signs Your Period Is Coming?Knowing the signs of a period can help you deal with your menstrual symptoms. Learn how to identify the signs of a period, know when to see a doctor, and find treatment for your period symptoms. Pregnancy is the time when a baby develops in the womb. A period is the time in a woman's monthly cycle in which she bleeds and sheds uterine lining. Early pregnancy symptoms may be confused with period symptoms because they can be similar.
What Is the Normal Cycle for Menstruation?A normal menstrual cycle typically lasts about 28 days long. Check out the center below for more medical references on menstruation, including multimedia (slideshows, images, and quizzes), related disease conditions, treatment and diagnosis, medications, and prevention or wellness.
Why Am I Getting Brown Discharge Before My Period?What is brown discharge and why does it sometimes happen before your period? Learn the signs of abnormal vaginal bleeding and what the causes may be.