Definition and Overview

Amenorrhea is a general term used to describe the absence of menstruation.

All women, by the time they are born, already have the number of eggs they would ever need in their lifetime to reproduce. These eggs are stored in the ovaries. By the time they reach the menstrual age, which is when the female reaches between 12 and 15 years old, the eggs are released and travel through the fallopian tube where they will be waiting to be fertilized by a men’s sperm.

The reproductive system undergoes other changes during menstruation such as the thickening of the wall of the uterus, a huge stretchable sac where the potential embryo is expected to develop and become a baby. If the eggs are not fertilized, the uterine wall sheds its thickened tissue in the form of blood, which is then referred to as menstruation.

The majority of women go through a regular menstrual cycle, which is about every 28 days, and they menstruate for about five to seven days. In certain cases, menstruation can be irregular, in which case a woman will experience amenorrhea, which means she does not bleed.

Amenorrhea can develop due to several factors. The causes are generally classified into two: primary and secondary.

It is considered primary amenorrhea if the patient doesn’t menstruate after reaching 14 to 15 years old. This may be accompanied by the lack of development of sexual characteristics, particularly breast growth. It can also be primary if the woman has developed sexual attributes but still do not have menstruation after turning 16 years old. All other possible reasons for amenorrhea are deemed secondary.

Causes of Condition

Here are the possible causes of amenorrhea:

  • Pregnancy – One of the most common signs of pregnancy is the lack of menstruation, especially if the woman has a regular period. During pregnancy, the body undergoes different changes that include the decreased production of estrogen and increased progesterone, which prevent the woman from shedding the lining of the uterus that may lead to menstruation and possible loss of the baby.

  • Menopause – Menopause refers to a period in a woman’s life when she stops menstruating, which also means she’s no longer ovulating and that she can no longer reproduce. A woman is believed to be in menopause if she doesn’t have any period for at least a year and if she’s between 40 and 50 years old. Menopause is a biological process, although it can be induced such as when the woman goes through chemotherapy treatment.

  • Breastfeeding – Lactation amenorrhea (LAM) is a condition wherein the new mother doesn’t menstruate at least within the first six months after giving birth. For the condition to be considered LAM, the woman should not have menstruation immediately after delivery, she is breastfeeding the baby on demand, and the baby is no more than six months old.

  • Medications – Certain medications including cancer drugs and contraceptives can prevent women from ovulating

  • Stress – Chronic stress can lead to serious changes in the body, especially in the hormonal levels. As hormones play a huge role in the reproduction, any changes can also affect the menstrual cycle, including the absence of monthly periods.

  • Changes in the body – People who are involved in strenuous exercises or are seriously underweight may also experience amenorrhea due to disruption in the hormones, stress, and low body fat.

  • Congenital – Some women are born without a uterus, for example, in which case they are not capable of getting pregnant and menstruating.

  • Metabolic condition – Conditions such as polycystic ovarian syndrome (PCOS) are related to amenorrhea normally due to changes in the hormones.

Key Symptoms

  • Absence of menstruation (bleeding or spotting is not considered as menstruation)
  • Infertility
  • Hirsutism (excessive hair growth)
  • Abnormal weight (either too much or low weight)
  • Headache
  • Anxiety or depression
  • Night sweats
  • Changes in sleep pattern
  • Dryness of the vagina
  • Hot flash

Note that the main symptom of amenorrhea is the absence of menstruation usually within three months after the last period. This should already be enough to seek help from a health care provider. All the other symptoms may be related to an underlying condition that can pinpoint the cause of amenorrhea.

Who to See and Treatments Available

Women who have amenorrhea can approach a gynecologist for a thorough checkup. The appointment may include a detailed review of the medical and family history, lifestyle, environment, and present reproductive concern.

The gynecologist may also request a series of tests to get a more definitive diagnosis. These exams may include:

  • Hormone tests including thyroid panel tests
  • Pelvic ultrasound to determine if there are congenital defects or other physical abnormalities on the reproductive system
  • MRI of the head to rule out any problem with the pituitary gland or hypothalamus, which helps regulate hormone levels

Treatments vary depending on the root cause and may include:

  • Maintaining a healthy weight
  • Eating a balanced diet
  • Limiting exercise – Exercise is an important part of a person’s lifestyle. It is necessary to maintain the ideal weight, especially if the woman is already considered overweight or obese. However, too much of it can also cause amenorrhea. Health experts suggest limiting exercise to no more than 8 hours per day. A 30-minute exercise per day can already reduce the risk of serious conditions like obesity, diabetes, and heart disease.
  • Surgery to correct any physical abnormality such as obstruction
  • Treating the underlying condition

  • Bulun SE. The physiology and pathology of the female reproductive axis. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology, 12th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 17.

  • Lobo RA. Primary and secondary amenorrhea and precocious puberty: etiology, diagnostic evaluation, management. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 38.

  • Styne DM, Grumbach MM. Puberty, ontogeny, neuroendocrinology, physiology, and disorders. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology, 12th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 25.

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