What Is Absent Menstruation (Amenorrhea)?

What Is Absent Menstruation (Amenorrhea)?

Amenorrhea is the absence of menstrual periods.
It can mean either:

• A girl has not started her first period by age 15–16 (Primary Amenorrhea), or
• A woman who previously had periods stops bleeding for 3–6 months or more (Secondary Amenorrhea).

Normal Situations Where Absence of Periods Is Expected

Amenorrhea is normal:

• Before puberty
• During pregnancy
• While breastfeeding
• After menopause

Outside of these times, amenorrhea may indicate a health condition.

Types of Amenorrhea

Common Causes

1] Natural Causes

• Pregnancy (most common)
• Breastfeeding
• Menopause

2] Lifestyle Factors

• Too low or too high body weight
• Intense exercise (athletes, dancers, gymnasts)
• Severe stress
• Poor nutrition or eating disorders (anorexia, bulimia)

3] Hormonal Imbalances

• PCOS (Polycystic Ovary Syndrome)
• Thyroid disorders
• High prolactin levels (sometimes from pituitary gland tumors)
• Low estrogen or high testosterone

4] Medications

• Antipsychotics
• Antidepressants
• Chemotherapy drugs
• High blood pressure medications
• Suddenly stopping birth control pills

5] Structural or Anatomical Problems

• Missing or blocked reproductive organs (uterus, vagina, cervix)
• Scarring in the uterus (Asherman’s syndrome)

6] Genetic Conditions

• Turner syndrome
• Androgen insensitivity syndrome

When to See a Doctor

See a doctor if:

• A girl is 16+ with no first period
• A girl is 14+ with no signs of puberty
  (breast growth → pubic hair → periods)
• A woman has missed 3 or more periods in a row
• There are symptoms such as:
  • Excess facial/body hair
  • Milk discharge from breasts
  • Hot flashes (early menopause)
  • Severe weight loss or gain

How Doctors Diagnose Amenorrhea

Tests May Include:

1. Pregnancy test
2. Blood hormone tests:
   • Estrogen
   • FSH & LH
   • Prolactin
   • Thyroid hormones
   • Testosterone
3. Pelvic Ultrasound — to look at ovaries and uterus
4. MRI or CT scan — if a brain/pituitary problem is suspected

Treatment

Treatment depends on the cause:

Possible Complications if Amenorrhea Lasts Long-Term

• Infertility (may not be ovulating)
• Bone thinning (osteoporosis) due to low estrogen
• Increased heart disease risk
• Emotional stress or body-image concerns

Key Takeaway

Amenorrhea is not a disease itself — it is a symptom.
The goal is to find and treat the underlying cause.

If periods stop unexpectedly, don’t panic — but do consult a doctor, especially if pregnancy is ruled out and the absence lasts 3 months or more.