What Is Amenorrhea?

Amenorrhea is a medical term for a lack of menstruation in women who have undergone puberty. Primary amenorrhea applies to individuals who have reached 16 years of age without beginning menses. Secondary amenorrhea is the absence of periods for three months or more in women who have previously menstruated. If those periods were sometimes irregular, then the interval of absence is six months. Amenorrhea has a variety of medical causes. It is also a natural and expected aspect of pregnancy and menopause.

Primary amenorrhea is rare, while secondary amenorrhea is more common. To learn more about amenorrhea, including ways to treat and reverse the symptoms, turn to the gynecologists at Baptist Health.

What Are Amenorrhea Symptoms?

The chief symptom of amenorrhea is the absence or interruption of regular menstruation. Other symptoms sometimes associated with amenorrhea include:

• Headaches
• Vision problems
• Hair loss
• Growth of facial hair
• Acne
• Nipple discharge
• Pelvic discomfort.

At greater risk for amenorrhea are individuals:

• With a family history of this condition
• With eating disorders
• Who train athletically or are active in sports
• Who have undergone certain gynecological procedures, such as a dilation and curettage (D&C), which can lead to uterine scarring.

What Causes Amenorrhea?

Amenorrhea has a wide range of causes, both natural and medical. In some cases, it is a symptom of another, underlying health condition. Some causes are also lifestyle-related.

Medical Causes of Primary Amenorrhea

Primary amenorrhea occurs when a woman reaches age 16 without having her first period. Among its chief causes are:

• Genetic abnormalities: Turner syndrome, androgen insensitivity syndrome, and other genetic conditions can disrupt the functioning of a woman’s reproductive organs.
• Hormonal problems: The reproductive cycle is governed by hormone production. An imbalance in hormone levels, caused by problems with the hypothalamus, thyroid, or pituitary gland, reduces the likelihood of menstruation.
• Structural issues: Missing or damaged organs or related problems with physical anatomy can result in an underdeveloped reproductive system.

Medical or Lifestyle Causes of Secondary Amenorrhea

Secondary amenorrhea is defined as the interruption of regular menstruation for at least three months and irregular menstruation for at least six months. Causes include:

• Medications: Certain medications can suppress menstruation, including blood pressure drugs, antidepressants, antipsychotics, chemotherapy drugs, and some allergy treatments.
• Contraceptive use: Birth control pills, intrauterine devices (IUDs), and injectable contraceptives all impact the reproductive system. The resumption of normal cycles can take several months after contraceptive use has ended. 
• Gynecological conditions: Polycystic ovarian syndrome (PCOS), fragile X-associated primary ovarian insufficiency (FXPOI), and other such conditions are linked to hormonal imbalances that interrupt the menstrual cycle.
• Hypothalamic amenorrhea: The hypothalamus initiates menstruation with the release of a hormone called GnRH. If production of this hormone declines, it can delay or halt the monthly cycle.
• Thyroid conditions: Like the hypothalamus, the thyroid is a hormone-producing organ involved in governing the menstrual cycle. A thyroid that is either overactive (a condition known as hyperthyroidism) or underactive (hypothyroidism) can create irregularities in the cycle.
• Tumors: Pituitary gland tumors, whether cancerous or benign, can negatively affect menstruation. 
• Stress: Individuals undergoing stressful life situations are more likely to miss monthly periods than those who aren’t (or who have better coping strategies).
• Weight issues: Both obesity and low-weight conditions, such as those caused by anorexia nervosa, can have a negative impact on menstrual cycles. This means that diet and exercise – when, how often, and how much – sometimes play a role in a woman experiencing amenorrhea.

How Is Amenorrhea Diagnosed?

Amenorrhea can be difficult to diagnose, sometimes requiring multiple tests and procedures. Diagnosis typically begins with a gynecologist-office visit. Your doctor will ask about your symptoms, note your family medical history, and conduct a physical and pelvic exam. He or she may also order a pregnancy test, if you have been sexually active. Additional steps might include:

• Bloodwork: Bloodwork can reveal hormone imbalances that are associated with amenorrhea. Targeted are prolactin, thyroid-stimulating hormone, follicle-stimulating hormone, and various male hormones.
• Hormone challenge test: This test involves taking a hormone which should result in menstrual bleeding when you stop its use. An absence of bleeding may mean too-low estrogen levels.
• Hysteroscopy: This procedure is a visual inspection of the uterus using a tiny camera and light on the end of a thin flexible tube that is inserted through the cervix and vagina.
• Imaging tests: Computerized tomography (CT), ultrasound, and magnetic resonance imaging (MRI) technologies can document organ abnormalities or the presence of tumors in the reproductive or endocrine systems.

Your gynecologist might also order a chromosomal test to look for a possible underlying genetic abnormality (for example, incomplete or missing X chromosomes linked to Turner syndrome).

How Is Amenorrhea Treated?

Amenorrhea is treated based on type (primary or secondary). Medical treatment typically involves hormone therapy and, less frequently, surgery. Lifestyle remedies include:

• Changes in diet to establish a healthy body weight
• Adjustments in exercise routines
• Adoption of stress-management techniques.

Amenorrhea is a not life-threatening condition. Nevertheless, it should be properly diagnosed and treated, if for no other reason than it may be symptomatic of a more serious underlying medical issue. If handled in this manner, a woman’s menstrual cycle can often be restored.

Can Amenorrhea be Prevented?

Problems with menstruation may not be preventable but a wellness lifestyle can limit potential causes of secondary amenorrhea:

• Adopt a healthy and nutritionally balanced diet
• Control your weight with regular but moderate exercise
• Get sufficient sleep
• Pay attention to what your body is telling you during your monthly cycles
• Get regular gynecological checkups, including Pap smears and pelvic exams.

Learn More About Amenorrhea at Baptist Health

For more information about amenorrhea diagnosis and treatment, or to schedule an appointment, please contact your Baptist Health gynecologist.