Amenorrhea

Causes of amenorrhea

The cause of amenorrhea will differ based on the type of amenorrhea. Primary amenorrhea occurs in girls who have not had their first period by the age of 16. Secondary amenorrhea happens for women who have been through puberty and had a normal cycle and now have not had a period for more than 3 months.

There are two main causes of primary amenorrhea:

• Genetic abnormalities – abnormalities such as Turner syndrome, a condition where a girl is born without a X chromosome, and androgen insensitivity syndrome, a condition where a girl has high levels of testosterone
• Hypothalamus or pituitary gland abnormalities – these condition can lead to hormonal imbalances, which can delay menstruation in girls

Causes of secondary amenorrhea include:

• Pregnancy, breastfeeding and menopause are natural causes of amenorrhea
• Medications such as birth control pills, IUDs (intrauterine device for birth control), antidepressants, blood pressure medications, chemotherapy and radiation can cause a woman to consistently miss her period
• Women who have low body weight, an eating disorder, emotional stress, physical stress or participate in strenuous exercise may experience amenorrhea, if the hypothalamus stops releasing gonadotropin-releasing hormone (GnRH) — the hormone that starts the menstrual cycle
• Gynecologic conditions that can lead to hormone imbalances such as polycystic ovarian syndrome and fragile X, both associated with primary ovarian insufficiency
• Thyroid problems including hypothyroidism or hyperthyroidism
• A tumor on the pituitary gland can interfere with your body’s regulation of the hormones that affect menstruation

Risks factors for amenorrhea

There are a variety of risk factors that could increase your likelihood of developing amenorrhea including:

• Excessive exercise
• Obesity
• Anorexia nervosa
• Family history of early menopause or amenorrhea
• Genetic composition – having the FMR1 gene

Symptoms of amenorrhea

The primary sign of amenorrhea is missing a period for three or more consecutive months.

Other symptoms of amenorrhea may include:

• Hair loss
• Headache
• Vision changes
• Pelvic pain
• Growing facial hair
• Discharge from the nipple
• Acne

Diagnosis of amenorrhea

Your doctor will order a pregnancy test to rule out the chance you are pregnant before running any other tests. If the pregnancy test is negative, your doctor will run a series of blood tests to evaluate your levels of testosterone, estrogen and hormones in your blood.

Other tests that your doctor may order include:

Hormone challenge test 

Your doctor will give you hormone medication until it triggers menstruation. This test can evaluate the amount of estrogen in your body. If your estrogen is very low, that could explain missing regular periods.

Diagnostic imaging 

In some cases, your doctor will use diagnostic imaging tests such as an MRI, CT scan or ultrasound to obtain detailed images of your internal organs. The images will clearly show any cysts or other growths on or in your reproductive organs that could be preventing menstruation.

Scope tests

Your doctor may order a hysteroscopy to get a close-up view of the inside of the uterus to further look for cysts and other abnormalities. During a hysteroscopy, a lighted camera is inserted into the uterus via the vagina.

Treatment of amenorrhea

Your doctor will need to determine what is causing your amenorrhea to be able to effectively treat it. Treatment will vary based on the underlying cause of your condition.

Treatments for amenorrhea may include:

• Lifestyle changes – if you are experiencing amenorrhea due to factors such as exercising too much, not eating enough calories or if you are under excessive physical or mental stress, you can treat your condition by making lifestyle modifications
• Medications – hormonal imbalances caused by issues with the thyroid or pituitary gland may be treated with supplemental or synthetic hormones
• Surgery – structural issues and growths such as ovarian cysts, a tumor or scar tissue buildup in the uterus may need to be treated with surgical intervention