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 periods, you’re probably wondering what’s going on with your body.

What is amenorrhea?

Amenorrhea is considered a “menstrual condition”. There are 2 types of amenorrhea: primary and secondary.

Primary amenorrhea is the term used when a young woman has never had a period. Most girls should get their periods between 9 and 15 years old or about 2 to 3 years after they notice that their breasts are developing.

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 2 years after you started having them, and now they have not occurred in the past 3 months. Or your periods were irregular after you started having them, and now you have not had a period for at least 6 months.

What causes amenorrhea?

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

• Pregnancy– If a female is sexually active with a male partner and she doesn’t use contraception, or if her method of contraception has failed, amenorrhea could mean that she is pregnant.
• Changes in weight –A girl who loses or gains a lot of weight may have no periods or skip periods. Weight changes may happen because she does not have the right balance of foods to keep her body healthy or because she has a chronic disease.
• Disordered eating– Many girls will develop amenorrhea if they are too thin or have an eating disorder such as anorexia nervosa or bulimia.
• Exercise– Girls who participate in sports such as running or gymnastics may experience athletic amenorrhea. This can be due to low weight, weight loss, or stress. Even an athlete whose weight is normal may not be taking in enough nutrition to keep their body healthy, causing them to possibly skip periods.
• Polycystic Ovary Syndrome (PCOS)– Girls with PCOS typically have irregular menstrual cycles and excess hair growth or acne.
• Obesity– Being overweight makes a girl more likely to have irregular menstrual periods.
• Endocrine problems– Low or high thyroid hormone, too little or too much adrenal hormones such as cortisol, and too much prolactin, a hormone secreted by the pituitary gland in the brain, can cause irregular periods or amenorrhea. High prolactin levels can also be caused by medications such as risperidone.
• Chronic illness– Girls who have a chronic illness such as Crohn’s disease, celiac disease, cystic fibrosis, sickle disease, lupus, diabetes, and others may have irregular menstrual periods or amenorrhea because of low weight, stress, 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 may be taking.
• Ovary problems– Sometimes the ovaries do not make enough estrogen to cause periods because of a genetic problem such as Turner syndrome, 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 primary ovarian insufficiencyand is treated with hormones to replace the estrogen that the ovaries normally make.
• Congenital anomalies of the reproductive tract– A birth defect such as an underdeveloped or absent uterus (the organ where menstrual blood comes from) can cause lack of periods. 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. Other congenital anomalies may include an obstruction of the vagina, such as an imperforate hymen or absence of the lower vagina.
• Birth control (intrauterine devices (IUDs), implant, depot shot, continuous pills– Some birth control methods make you more likely to have no periods or skip periods. This is a normal side effect of these medications (and is why some women prefer these types of birth control). You should talk to your health care provider if you are concerned about pregnancy or amenorrhea on birth control. 

How is amenorrhea diagnosed?

Not having a period for more than a couple of months may not be normal, and finding out why is important. Amenorrhea may be completely normal if you are on birth control, but you should check with your health care provider if this is an expected side effect of your birth control method. 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? When did you develop breasts, pubic hair?
• 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 any foods you do not eat? Have you tried to lose weight through restricting what you eat, vomiting, or using laxatives? How hard do you have to work at keeping your weight where you want it?
• How much do you exercise? What activities?
• Do you feel like you have more hair on your face or abdomen than other women in your family?
• Have you ever had sexual contact or sexual intercourse?
• Do you use contraception?
• Do you take any medicines or herbs/supplements? 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 acne and any skin changes or excess hair. It’s important to tell your HCP if you have removed 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 needed 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 schedule you for an ultrasound.

Your HCP may then order 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?

Although many girls will skip an occasional period if they have just started their periods, or are stressed or ill, regular periods are a sign that you are healthy and making enough estrogen to keep your bones strong. So if you’re skipping periods, it’s important to find out why and whether you need a treatment plan.

Do I need to take any vitamins?

Your body needs 1300 mg of  calcium and 600 units of vitamin D each day. If you drink 4 (8 ounce) glasses of milk per day, you’ll get 1200mg. of calcium + vitamin D. Yogurt has about 400 mg of calcium.  Other dietary sources of calcium include calcium fortified: tofu, orange juice, and soy and rice milk. Choose calcium rich foods that you can enjoy throughout the 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

Our health guides are developed through a systematic, rigorous process to ensure accuracy, reliability, and trustworthiness. Written and reviewed by experienced healthcare clinicians from Boston Children's Hospital, a Harvard Medical School teaching hospital and consistently ranked as a top hospital by Newsweek and U.S. News & World Report, these guides combine clinical expertise, specialized knowledge, and evidence-based medicine. We also incorporate research and best practices from authoritative sources such as the CDC, NIH, PubMed, top medical journals, and UpToDate.com. Clinical specialists and subject matter experts review and edit each guide, reinforcing our commitment to high-quality, factual, scientifically accurate health information for young people.