Amenorrhea is the absence of menstrual periods in women of reproductive age. While it can sometimes be normal such as during pregnancy, breastfeeding, or menopause.

Amenorrhea may also be a sign of an underlying medical condition that requires evaluation and treatment.

Types of Amenorrhea

Amenorrhea is generally classified into two categories:

Primary Amenorrhea:

When menstruation has not started by the age of 15, even though other signs of puberty (such as breast development or pubic hair growth) have appeared.

Secondary Amenorrhea:

When a woman who previously had regular menstrual cycles stops having periods for three or more consecutive months, or for six months in women with irregular cycles.

Common Causes

The causes of amenorrhea vary depending on age, medical history, and lifestyle. They can be divided into natural, lifestyle-related, and medical factors.

Natural Causes

Pregnancy

Breastfeeding

Menopause

Lifestyle Factors

Significant weight loss or eating disorders

Excessive physical exercise (common in athletes)

High stress levels

Poor nutrition

Medical Causes

Polycystic Ovary Syndrome (PCOS): A hormonal imbalance that affects ovulation.

Thyroid Disorders: Both hyperthyroidism and hypothyroidism can interfere with menstruation.

Pituitary Gland Disorders: Tumors or dysfunction affecting hormone production.

Premature Ovarian Failure (Early Menopause): Ovarian function ceases before the age of 40.

Uterine Scarring (Asherman’s Syndrome): Scar tissue inside the uterus, often after surgery or infection.

Chronic Illnesses: Such as diabetes or celiac disease.

Symptoms

In addition to missed periods, women with amenorrhea may experience:

Headaches or vision changes

Hair loss or excessive hair growth

Acne or oily skin

Hot flashes or night sweats

Vaginal dryness

Changes in weight or appetite

Milky discharge from the breasts (galactorrhea)

When to See a Doctor

Consult a healthcare provider if you:

Have missed three or more consecutive periods and are not pregnant.

Have not started menstruating by age 15.

Experience additional symptoms such as fatigue, headaches, or vision problems.

Early evaluation is important to identify the cause and prevent complications such as infertility, osteoporosis, or hormonal imbalances.

Diagnosis

A doctor will perform a detailed medical history, physical examination, and may order tests such as:

Pregnancy test

Blood tests to measure hormone levels (FSH, LH, estrogen, prolactin, thyroid hormones)

Pelvic ultrasound to check for ovarian or uterine abnormalities

MRI or CT scan of the pituitary gland if a tumor is suspected

Treatment

Treatment depends on the underlying cause:

Lifestyle modifications: Improved nutrition, healthy weight management, and reduced stress or excessive exercise.

Hormonal therapy: To correct imbalances, including birth control pills or hormone replacement therapy.

Thyroid treatment: Medications to correct thyroid function.

Surgery: In cases of uterine scarring or pituitary tumors.

Fertility treatment: For women wishing to conceive.

Possible Complications

If left untreated, amenorrhea can lead to:

Infertility

Osteoporosis (bone loss) due to low estrogen levels

Cardiovascular issues related to hormonal imbalance

Emotional or psychological stress

Prevention & Management

Maintain a balanced diet and a healthy body weight.

Avoid excessive exercise without proper nutrition.

Manage stress through mindfulness, relaxation, or therapy.

Schedule regular gynecological check-ups.

Seek medical advice promptly for irregular menstrual cycles.

Amenorrhea is not a disease, but a symptom that can point to various underlying conditions. Identifying the cause early allows for effective treatment and helps maintain overall reproductive and hormonal health.

If you experience prolonged absence of periods, consult a qualified gynecologist or endocrinologist for proper evaluation and management.