amenorrhoea Alternative Names
absence of menstrual periods, missed menstrual periods
A woman who has amenorrhoea has either never had a menstrual period or has stopped having periods.
What is going on in the body?
There are two categories of amenorrhoea:
To have a period, a woman must have a normal, healthy:
- Primary amenorrhoea is not having had a period by age 16.
- Secondary amenorrhoea is the absence of periods in a woman who previously had regular menstrual cycles.
An abnormality in any of these may keep a woman from having a period.
- uterus, cervix (opening to the uterus, vagina), and ovaries
- pituitary gland
- hypothalamus, a structure within the skull that controls much of the body's hormone production
What are the signs and symptoms of the condition?
Amenorrhoea is not a disease. It is a symptom of certain health issues. Because it is often caused by a hormone imbalance, there may be other symptoms, such as:
What are the causes and risks of the condition?
- weight gain
- excess body and facial hair
- breast milk secretion
- changes in sex drive
- abnormal/late development of sexual structures (clitoris/breasts/pubic hair)
Primary amenorrhoea is usually due to late puberty rather than any permanent problem. The reason for this delay is generally not known, though it may be a family trait. Other possible causes are:
Pregnancy is the most common reason for secondary amenorrhoea. A woman's periods may also stop temporarily due to:
- a genetic disorder, such as Turner's syndrome
- a hormonal problem, such as an improperly functioning thyroid gland
A woman's periods may not start up again for a while after she stops using birth control pills, injections or implants. Usually, periods will start again within 3 to 6 months.
- birth control pills
- the birth control injection, such as medroxyprogesterone acetate
- hormone implants
Secondary amenorrhoea may also be linked to:
What can be done to prevent the condition?
- emotional stress
- poor nutrition
- drugs, such as tranquillisers or antidepressants
- rapid weight loss or gain
- chronic systemic illnesses, such as kidney failure or cancer
- too much exercise
- recent surgery
- a hormonal imbalance, such as polycystic ovary syndrome (PCOS)
By maintaining a healthy lifestyle, a woman may be able to avoid secondary amenorrhoea. A woman should:
If this seems too hard, she should ask for guidance from friends, family, or healthcare professionals.
- avoid smoking and alcohol or substance abuse
- maintain a healthy weight by adjusting her diet
- try to balance work and recreation
- lower her stress levels
How is the condition diagnosed?
Amenorrhoea is generally not life threatening, but it may be linked to certain health problems. When a woman reports it, her doctor will take a medical history and do a physical examination. He or she may also recommend:
These tests measure:
- a pregnancy test
- hormone tests
- special blood tests if a girl has not developed breasts or pubic hair by age 14
- blood tests if a girl or woman has breast discharge, headaches, vision changes, too much body hair or weight
- an ultrasound of the uterus and ovaries
Some tumours of the pituitary gland may cause elevated prolactin levels. Special X-rays of the head can show tumours in the pituitary.
- HCG hormone, which is a marker for pregnancy
- follicle-stimulating hormone (FSH), which is important in regulating the menstrual cycle and egg development
- oestradiol level, the main oestrogen in the body
- thyroid function
- prolactin, a hormone associated with certain tumours or thyroid gland abnormalities
- chromosome abnormalities that may prevent menstruation
What are the long-term effects of the condition?
Long-term amenorrhoea and oestrogen-deficiency may raise a woman's risk of excess bone loss and osteoporosis. This makes bones more likely to break.
A woman who wishes to get pregnant may be resistant to drugs that help induce ovulation. If PCOS is causing the amenorrhoea, long-term effects include: What are the risks to others?
What are the treatments for the condition?
If amenorrhoea has lasted less than 6 months, a woman may not need treatment unless she has worrisome symptoms or a problem is found:
Depending on the cause of amenorrhoea, treatment varies. Diet and exercise generally correct abnormal periods due to obesity. Stress management and not exercising too much helps, too.
- in her hormone levels
- on X-ray or ultrasound
Because ovaries are not producing eggs or certain hormones, a woman may be given:
Birth control pills and HRT drugs contain oestrogen and progesterone or sometimes progesterone alone. The hormones may be used to:
- birth control pills
- hormone replacement therapy (HRT) if she has reached menopause
- short-term oral progesterone pills or ovulation-inducing agents, such as clomiphene, for infertility
Surgery may be required for:
- induce a period
- prevent bone loss
Rarely, surgery is done when chromosome abnormalities are found.
- ovarian cysts
- defects in the uterus or vagina
What are the side effects of the treatments?
Hormones may cause minor side effects such as:
Occasionally, more serious side effects can occur with hormone therapy including blood clots, liver tumours, and endometrial cancer. Though these are quite rare, it is important for women to discuss the risks and benefits of hormone therapy with their doctor.
- breast tenderness
- PMS symptoms
- abdominal bloating
Drugs to induce ovulation may trigger:
What happens after treatment for the condition?
- hot flushes
- ovarian cysts
- mid-cycle pain
When a younger woman has amenorrhoea, normal periods often resume within a few years. Most women who are diagnosed and treated early can avoid surgery by taking hormones. If a woman wishes to get pregnant and not ovulating is the only infertility problem facing the couple, a success rate of 70% to 80% is possible.
After a woman stops taking birth control pills, she should get a period within a few months. If an unusual stress or illness has temporarily stopped a woman's periods, the problem will usually resolve on its own. It may recurr at a later date.
How is the condition monitored?
If a woman misses more than one period, she should talk with her doctor. It helps to:
Author: Eva Martin, MD
- check for pregnancy
- discuss any medications or supplements she is taking
- keep a record of periods, marking down length, days between cycles, frequency, and flow patterns
- find out if there is a family history of infertility, ovarian cysts, or irregular cycles
Reviewer: HealthAnswers Australia Medical Review Panel
Editor: Dr David Taylor, Chief Medical Officer HealthAnswers Australia
Last Updated: 1/10/2001
Potential conflict of interest information for reviewers available on request