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Amenorrhea is the absence of a menstrual period.

Amenorrhea is sometimes categorized as primary or secondary.

Secondary amenorrhea is more common than primary amenorrhea.

Having regular periods is an important sign of overall health. Missing a period, when not caused by pregnancy, breastfeeding, or menopause, is generally a sign of another health problem. If you miss your period, talk to your health care provider about possible causes, including pregnancy.

Symptoms of Amenorrhea

Missing a period is the main sign of amenorrhea. Depending on the cause, a woman might have other signs or symptoms as well, such as:

Risk Factors for Amenorrhea

According to the American Society for Reproductive Medicine, amenorrhea that is not caused by pregnancy, breastfeeding, or menopause occurs in 3% to 4% of women during their lifetime.

The risk factors for amenorrhea include:

Causes of Amenorrhea

Amenorrhea can happen for many reasons. It most often occurs as a natural part of life, such as during pregnancy or breastfeeding, but it can also signal a more serious condition.

Causes of primary amenorrhea

There are three main causes of primary amenorrhea:

Causes of secondary amenorrhea

Secondary amenorrhea can result from various causes, such as:

Diagnosis of Amenorrhea

Your health care provider will usually ask a series of questions to begin diagnosing amenorrhea, including:

Primary Amenorrhea

If you are older than 16 and have never had a period, your health care provider will do a thorough medical history and physical exam, including a pelvic exam, to see if you are experiencing other signs of puberty. Depending on the findings and on your answers to the questions above, other tests may be ordered to determine the cause of your amenorrhea.

Secondary Amenorrhea

If you are sexually active, your health care provider will likely order a pregnancy test. He or she will also perform a complete physical exam, including a pelvic exam.

You should contact your health care provider as soon as possible after you miss a period.

Other tests you may need include:

Your health care provider might use several of these tests to attempt to diagnose the cause of amenorrhea. In some cases, no specific cause for the amenorrhea can be found. This situation is called idiopathic amenorrhea.

Treatment of Amenorrhea

The treatment for amenorrhea depends on the underlying cause, as well as the health status and goals of the individual.

If primary or secondary amenorrhea is caused by lifestyle factors, your health care provider may suggest changes in the areas below:

Be aware of changes in your menstrual cycle and check with your health care provider if you have concerns. Keep a record of when your periods occur. Note the date your period starts, how long it lasts, and any problems you experience. The first day of bleeding is considered the first day of your menstrual cycle.

For primary amenorrhea, depending on your age and the results of the ovary function test, health care providers may recommend watchful waiting. If an ovary function test shows low follicle-stimulating hormone (FSH) or luteinizing hormone (LH) levels, menstruation may just be delayed. In females with a family history of delayed menstruation, this kind of delay is common.

Primary amenorrhea caused by chromosomal or genetic problems may require surgery. Women with a genetic condition called 46, XY gonadal dysgenesis have one X and one Y chromosome, but their ovaries do not develop normally. This condition increases the risk for cancer developing in the ovaries. The gonads (ovaries) are often removed through laparoscopic surgery to prevent or reduce the risk of cancer.

Treatment for secondary amenorrhea, depending on the cause, may include medical or surgical treatments or a combination of the two.

Medical Treatments for Secondary Amenorrhea

Common medical treatments for secondary amenorrhea include:

In general, medications are safe, but they can have side effects, some of which may be serious. You should discuss side effects and risks with your health care provider before deciding on any specific medical treatment.

Surgical Treatments for Secondary Amenorrhea:

Surgical treatment for amenorrhea is not common, but may be recommended in certain conditions. These include:

Most of the time, pituitary tumors are removed through the nose and sinuses. Radiation therapy may be used to shrink the tumor, either in combination with surgery or, for those who cannot have surgery, by itself.

How does amenorrhea affect bone health?

An important part of the menstrual cycle is the production of the hormone estrogen. Estrogen also plays a role in bone health. If amenorrhea is caused by low estrogen or problems with estrogen production, a woman may be at risk for loss of bone mass.

Some common causes of estrogen deficiency are excessive exercise and eating disorders. These can have a negative effect on bone density. Adolescent girls in particular need a combination of calcium, vitamin D, and physical activity to build strong bones during this critical time. Years ago, researchers found that girls with amenorrhea who diet are at risk for low bone density and that this condition increases their risk for osteoporosis later in life.

Amenorrhea that results from fragile X-associated primary ovarian insufficiency (FXPOI) also increases the risk for osteoporosis. It is important to see your health care provider as early as possible to begin investigating the cause of amenorrhea. According to one study, two-thirds of adolescent girls who reported FXPOI also had osteopenia, an early stage of osteoporosis, at their first visit.

When should I talk to my health care provider about a missed period or several missed periods?

If you have had regular periods or if there is any chance you may be pregnant, check with your health care provider about a missed period right away.

If you are just beginning to menstruate, keep in mind that it may take several months for your menstrual cycle to become regular. As you age, the time from the beginning of one cycle to the beginning of the next will likely range from 21 to 35 days, but your periods should become more regular over time.

See your health care provider right away if:

Can I still get pregnant if I have amenorrhea?

Yes, you can still get pregnant even if you do not have regular periods. Although some of the conditions that cause amenorrhea can also contribute to infertility, there is still a chance for pregnancy.

In addition, certain medical treatments for amenorrhea can increase the chances of pregnancy. If you do not want to become pregnant and you have amenorrhea, you should use contraception to prevent pregnancy.

Some women believe that they cannot get pregnant if they are breastfeeding and they aren't having menstrual periods. Unless a woman has gone through menopause, there is always the chance that she could get pregnant. If you are breastfeeding and want to prevent pregnancy, you should use a form of birth control to do so.

Reference: National Institutes of Child Health and Human Development