Amenorrhea

Amenorrhea, pronounced “a-men-or-re ah” means absent or no menstrual periods. If you haven't had your period yet or you've missed a few, you're probably wondering what is going on with your body. Read on to learn about the possible causes of amenorrhea.

What is amenorrhea?

Amenorrhea is considered a “menstrual condition”. There are two types of amenorrhea: primary and secondary.

Primary amenorrhea is the term used when a young woman has never had a period. Most girls get their periods between 9 and 15 years old, or about 2-3 years after they start their breast development.

Secondary amenorrhea is a term used when a young woman has had a period before, but stops having them. For example: Your periods were regular for the first two years and now they don't come at all. Or you only have 2 or 3 periods a year and sometimes 6 months goes by without a period.

What causes amenorrhea?

There are many possible causes of amenorrhea, including the following:

• Pregnancy - If a female is sexually active and she doesn't use contraception, or her method of contraception has failed, amenorrhea can mean that she is pregnant.
• Changes in weight and disordered eating - Many girls will develop amenorrhea if they gain or lose 5 pounds, are too thin (low BMI), have anorexia nervosa or bulimia or other disordered eating such as using vomiting or excessive dieting to control weight.
• Exercise - Girls who participate in sports such as running or gymnastics or in activities such as ballet often have athletic amenorrhea. This can be due to low weight, weight loss, or stress. Even an athlete who weighs a normal amount may not be taking in enough nutrition to keep her body healthy and may skip periods.
• Polycystic Ovary Syndrome (PCOS) - Girls with PCOS typically have irregular menstrual cycles and excess hair growth or acne, and are often overweight. For some girls the menstrual cycles occur 6 to 8 times a year, but for others only 1 to 3 times a year. So girls with PCOS may have amenorrhea for 3 to 6 months or more.
• Obesity - Being excessively overweight makes a girl more likely to have irregular menstrual periods, high blood pressure and diabetes.
• Endocrine problems - There are a number of endocrine problems such as low or high thyroid hormone, too little or too much adrenal hormones such as cortisol, and too much prolactin which is secreted by the pituitary gland in the brain that can cause irregular periods or amenorrhea. High prolactin levels can also be caused by medications such as resperidol.
• Chronic illness - Girls with many diseases such as Crohn's disease, cystic fibrosis, sickle disease, lupus, diabetes, and others may have irregular menstrual periods or amenorrhea because of low weight or a flare in their illness.
• Medications and herbs - Some medications can cause amenorrhea. Be sure to tell your health care provider about ALL the medications and/or over-the-counter supplements and herbs that you take.
• Ovary problems - Sometimes the ovaries do not make enough estrogen to cause periods because of a genetic problem such as Turner syndrome or galactosemia, previous radiation or chemotherapy to treat a tumor, lack of enough follicles in the ovary for the teen and adult years, and many other reasons. The condition is called premature ovarian insufficiency and is treated with hormones to replace the estrogen you are not making.
• Congenital anomalies of the reproductive tract - A congenital anomaly of the reproductive tract is a type of birth defect. The uterus (the organ where menstrual blood comes from) can be underdeveloped or absent. Although rare, if a teen girl is 15 or older or started her breast development 3 years ago and doesn't have her period yet, a congenital anomaly may be considered and an ultrasound may be ordered by her health care provider to see if the uterus has developed.

How is amenorrhea diagnosed?

Not having a period for more than a couple of months isn't normal, and finding out why is important. Diagnosis starts with having a pregnancy test and a medical evaluation by a health care provider (HCP).

The exam begins with reviewing your medical history.

For example, your HCP will likely ask the following questions:

• When did you start to go through puberty and develop breasts?
• Have you ever had any vaginal bleeding?
• When was your last menstrual period?
• Has your weight changed?
• Are you under stress or depressed?
• Do you have an eating disorder or vomit to try to control your weight?
• How much do you exercise?
• Do you have excessive hair growth or gain weight easily?
• Have you ever had sexual intercourse?
• Do you use contraception?
• Do you take any medicine? If so, what?

The other part of the evaluation is a physical exam. Your HCP will listen to your heart and lungs, check your thyroid gland (in your neck), and check your body for any skin changes or excess hair. It's important to tell your HCP if you remove any unwanted hair, particularly on your face (upper lip/sideburns/chin) or on your chest or back.

Your HCP will tell you if a pelvic exam is important to make sure that everything is okay with your hymen, labia, vagina, cervix and uterus. Instead of a complete pelvic exam, your HCP may do certain parts of the pelvic exam such as checking to make sure your hymen is open and using a small Q-tip in your vagina to make sure the length is normal. Your HCP may also have you get an ultrasound.

Your HCP may then obtain blood tests to look at hormone levels or refer you to a specialist in adolescent medicine or gynecology who sees girls with irregular periods.

Does it matter if you skip periods?

Many girls will skip an occasional period if they are ill, stressed, have just started their periods, or are away at camp in August, but regular periods are sign that you are healthy and making enough estrogen to keep your bones strong. So if you are skipping periods, it is important to find out why and discuss with your HCP if you need treatment. Make sure that you take in 1200-1500 mg of calcium and vitamin D (600 units/day).

What is the treatment for amenorrhea?

Treatment depends upon the cause of the amenorrhea and may include:

• Changing your exercise pattern
• Talking with a nutritionist and eating a healthy diet
• Seeing a counselor about stress or disordered eating
• Hormones such as progesterone, estrogen, or birth control pills

What's important is that you listen to the options and decide what type of treatment is best for you.

Most conditions that cause amenorrhea can be treated with medication and lifestyle changes. Make sure you are taking in enough calcium and vitamin D.

Written and reviewed by the CYWH Staff at Children's Hospital Boston

Updated: 12/1/2010

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Polycystic Ovary Syndrome

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