Amenorrhea (Absence of Periods) : Causes, Symptoms and Treatment
Medically Reviewed by Dr K. Hari Chandana MBBS, MS
As you know, women experience menstrual periods every month regularly. But, have you ever wondered what it’s like to have no periods at all? . Periods are something that women hate to have but are scared not to have at the same time and yes, you must be concerned if you don’t get periods & this condition in medical terms is known as amenorrhea which is also referred to as absent periods.
What exactly is amenorrhea?
The term “amenorrhea” literally means “the absence of periods”–which is observed in a woman during her reproductive years i.e., after the age of puberty and before the age of menopause. This condition is naturally seen in pre-puberty girls and after menopause.
There are other natural reasons why you don’t get periods at all- such as during pregnancy and breastfeeding. However, you can be certain what you are going through is not natural if you don’t get periods for more than 6 months, without any of these natural causes.
Amenorrhea is generally seen in 1.5- 3% of women during their reproductive years. Whereas, less than 1% of women are affected by this issue
What is a Menstrual Cycle?
Menstruation, also called periods, occurs when the lining of your uterus sheds and breaks down into blood which leaves your body through the vagina. These periods last around 2- 7 days and the average length of the menstrual cycle is around 28-29 days which may differ from person to person. Most women experience their first menstruation between the ages of 9- 15.
There are some complex hormones in your body which control your menstrual cycle and every month, these hormones are released in a particular order to prepare the uterus and the rest of the body for pregnancy. So, if everything is going smoothly and you are not pregnant, the uterus sheds its lining. This shedding will lead to menstruation. Once your period starts, the cycle begins again.
But for some reason, if the hormonal system doesn’t work properly, it may lead to amenorrhea( absence of periods).
Types of amenorrhea
There are mainly two types of amenorrhea:
1.Primary amenorrhea
2.Secondary amenorrhea
Primary amenorrhea:
- It occurs when the periods do not start during puberty.
- If the periods do not start by the age of 16, you should seek medical attention immediately.
- Primary amenorrhea is rare and it is estimated that less than 0.1% of the population is affected.
Secondary amenorrhea:
- Secondary amenorrhea occurs when your periods begin, but then they stop for at least 3 months or if your periods are irregular and then stop for 6 months.
- According to the studies, 41% of women are affected with secondary amenorrhea.
- Secondary amenorrhea is confirmed if you:
- used to have periods regularly and then stopped for 3 months.
- Used to have irregular periods and then stopped for 6 months
- However, this is natural in case of pregnancy and breastfeeding but sometimes it may also mean that there is a problem.
Athletic amenorrhea:
- As the name suggests, this type of amenorrhea occurs in athletes like runners.
- It occurs when excessive exercise suppresses the release of oestrogen, causing periods to stop.
- Many studies have shown that amenorrhea is particularly common in females who are long-distance runners.
What Causes Amenorrhea?
There is no doubt that periods are the most inconvenient and irritating, but the truth is that it’s not normal for women to have no periods at all. Because a woman’s body is designed to have menstrual cycles every month except when they are pregnant and if you are not having periods, that means there is something wrong with your body.
There are various reasons why you are not having periods and you must find out what exactly is causing your amenorrhea.
Different types of amenorrhea have different causes. Some occur due to natural reasons, while others might be due to a medical condition.
Natural causes of amenorrhea( absence of periods) include:
- Pregnancy
- Breastfeeding
- Menopause
- Removal of uterus or ovaries via surgery
Causes of primary amenorrhea include:
- One of the most common causes of primary amenorrhea is having a family history of delayed menstruation or sometimes, a genetic problem.
- Turner syndrome– means a child has only one copy of the x chromosome. This leads to high levels of testosterone.
- Müllerian defects– which means the uterus and fallopian tubes do not form as they should i.e., malformation of reproductive organs.
- Structural problems– related to genitals which are present by birth. Sometimes, the uterus and fallopian tubes may be missing while sometimes these tubes do not come together properly.
- In a few cases, the ovaries, breasts and clitoris (a female sex organ) form correctly. Still, there is no vaginal opening and the cervix(a narrow passage at the lower end of the uterus that connects the uterus to the vagina) & uterus may not form correctly.
In these types of cases, menstruation may not be possible as the reproductive development will not follow the usual manner.
Causes of secondary amenorrhea include:
- It might be because of a gynaecological disorder or a serious illness.
- Eating disorders like anorexia or bulimia (it’s an eating disorder which is characterized by eating secretly large amounts of food and then puking or use laxatives, or diet pills and exercising excessively to lose weight later)
- Low BMI(Body Mass Index)– if it falls below 19, one is at more risk of developing secondary amenorrhea.
- Chemotherapy and radiotherapy
- Poor nutrition
- Some birth control pills
- Extreme exercises
- Some medications like antipsychotics, antidepressants, allergy medications
Other conditions which can cause secondary amenorrhea include:
- Polycystic ovarian syndrome (PCOS)
- Adrenal disorders or hypothyroidism
- Pituitary disorders
- Hypothalamic amenorrhea– occurs due to an issue with a structure present in your brain which helps your body to be balanced in a stable state. It controls your sleep and growth.
- Ovarian tumours (abnormal growth on the ovaries)
- Obesity
- Kidney diseases
What are the signs & symptoms of amenorrhea(absence of periods)?
The main symptom is lack of menstruation but there are other symptoms depending on the causes.
- Hair loss
- Headache
- Vaginal dryness
- Vision changes
- Excessive hair growth on your face and body
- Lack of breast development in primary amenorrhea
- Hot flashes
How do you diagnose amenorrhea?
Amenorrhea is not a diagnosed condition, it is a symptom of other conditions. So, this needs to be investigated and treated as early as possible.
Primary amenorrhea:
If you haven’t started your periods by the age of 16, the physician may ask about your family history and carry out a few tests to assess the level of your hormones:
- Follicle-stimulating hormone (FSH)-- which helps control your menstrual cycle & stimulate the growth of eggs
- Luteinizing hormone (LH)-- helps produce hormones needed for pregnancy and in ovulation.
- Thyroid-stimulating hormone (TSH)-- if the TSH levels are high, it means amenorrhea(absence of periods) is caused due to hypothyroidism.
A physical examination will also be carried out.
Secondary amenorrhea:
The diagnosis for secondary amenorrhea will focus on the underlying cause of the issue.
First, the physician may ask you a few questions regarding your:
- Menstruation– if it’s regular and when did it start, how many days they lasted and how heavy they were.
- Pregnancy
- Family history
- If there is weight loss or weight gain
- If there are any heavy or excessive exercises
Then they recommend a few tests which may include:
- Pregnancy test
- Thyroid tests
- Ovary function test
- prolactin
- Other hormone tests
Radiological or imaging tests include:
- An ultrasound, MRI or CT scan and hysteroscopy in which a doctor passes a thin, lighted camera through your vagina and cervix to have a look and examine the uterus from inside.
How is amenorrhea treated?
Since there are many causes of amenorrhea( absence of periods), the treatment will be according to the underlying cause of amenorrhea.
Some treatments include restarting your periods through birth control pills and other types of hormonal therapies.
Your treatment will depend on the cause of amenorrhea and these treatment options for secondary amenorrhea include:
- Lifestyle changes: A healthy diet and a change in exercise plan may help you to stabilize your monthly cycle.
- Stress management
- Do not hesitate to talk to your family, friends and mental health professional to help you reduce stress.
- Try some relaxation techniques like yoga, meditation, etc might also help you.
- Follow a weight loss diet.
- Hormonal replacement therapy might help you to get your menstruation back.
- Oestrogen therapy will help you to relieve vaginal dryness and hot flashes.
- Calcium and vitamin D supplements will keep your bones strong.
- If menopause starts early, you may be at risk to develop osteoporosis, so you should get treated immediately.
Do I need to get surgery for amenorrhea?
It’s rare to get surgery for amenorrhea but your physician may recommend it if you have the following:
- Pituitary tumour– abnormal growth in the pituitary gland which is located behind your nose and at the base of your brain.
- Uterine scar tissue– also called Asherman's syndrome, where scar tissue or adhesion builds up in your uterus.
- Vaginal bleeding
Contact your doctor if you miss your periods for 3 months and if you:
- Have trouble with your vision
- Excessive body hair growth
- Haven’t got your period age the age of 15
- Producing breast milk even if you are not pregnant
- Having periods less than 9 times a year
- Changes in the pattern of your periods
- Not showing any signs of puberty at the age of 13
Bottom line:
Amenorrhea isn’t life-threatening. It is treatable in most cases. Lifestyle changes & getting treated for amenorrhea(absence of periods) will help you to get your periods back so you can get pregnant.
Always keep track of your periods, follow a healthy diet, and medications you are taking and if you’ve missed several periods in a row consult your doctor to find out what’s causing it. If you wish to become pregnant, your physician will guide you about fertility options.
Frequently Asked Questions
Amenorrhoea is treatable in most cases and the treatments will help you to get your periods back. It might take a few months for your periods to come back, but they will in most cases.
There are many treatment options if you wish to get pregnant which include: medications which can stimulate ovulation, correct hormonal imbalances and in a few cases surgery will be necessary.
There are also lifestyle changes which can reverse your amenorrhoea. But, if you are suffering from amenorrhoea and wish to be pregnant, speak with your doctor as they can help determine the cause and discuss the treatment options and help your family grow.
It’s normal to miss one or two periods in your lifetime like:
- When you start getting your periods
- During pregnancy
- While breastfeeding
- In the lead-up to Menopause