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Amenorrhea – Causes, Symptoms and Treatment

Amenorrhea refers to the absence of menstruation. It can be primary or secondary and may result from hormonal, anatomical, or systemic causes.

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Things worth knowing about "Amenorrhea"

Amenorrhea refers to the absence of menstruation. It can be primary or secondary and may result from hormonal, anatomical, or systemic causes.

What Is Amenorrhea?

Amenorrhea (also spelled amenorrhoea) is the absence of menstrual periods. There are two main types: primary amenorrhea, in which menstruation has never begun by age 15, and secondary amenorrhea, in which previously regular periods stop for three or more consecutive months. Amenorrhea is not a disease in itself but rather a symptom pointing to an underlying cause that requires evaluation.

Causes

Primary Amenorrhea

Chromosomal abnormalities (e.g., Turner syndrome)
Congenital malformations of the reproductive tract (e.g., absent uterus or vagina)
Delayed puberty
Hypothalamic or pituitary dysfunction

Secondary Amenorrhea

Pregnancy (most common cause)
Hormonal disorders: thyroid disease, elevated prolactin levels (hyperprolactinemia), polycystic ovary syndrome (PCOS)
Significant weight loss or low body weight (e.g., in anorexia nervosa)
Intense athletic training (exercise-induced amenorrhea)
Chronic stress
Asherman syndrome (intrauterine adhesions)
Premature ovarian insufficiency (early menopause)
Certain medications (e.g., antipsychotics, some contraceptives)

Symptoms

The primary symptom is the absence of the menstrual period. Depending on the underlying cause, additional symptoms may include:

Hot flashes and night sweats (due to hormone deficiency)
Acne and excessive body hair (in cases of hyperandrogenism, e.g., PCOS)
Milky nipple discharge without pregnancy (galactorrhea, due to elevated prolactin)
Headaches or visual disturbances (in cases of pituitary tumor)
Changes in body weight
Mood swings, anxiety, or depression

Diagnosis

Evaluation of amenorrhea typically follows a stepwise approach:

Medical history and physical examination: Assessment of health history, body weight, stress levels, and physical activity
Pregnancy test: The first step in evaluating secondary amenorrhea
Blood tests: Hormone levels including FSH, LH, estradiol, prolactin, TSH, and androgens
Ultrasound: Evaluation of the uterus and ovaries
MRI or CT scan: If a pituitary tumor or anatomical abnormality is suspected
Chromosomal analysis: In primary amenorrhea to rule out genetic causes

Treatment

Treatment is directed at the underlying cause:

Hormone therapy: Replacement of deficient hormones such as estrogen, progesterone, or thyroid hormones
Weight restoration: Nutritional therapy is central when low body weight is the cause
Stress reduction and exercise modification: Reducing excessive physical training loads
Medications: For example, dopamine agonists (cabergoline, bromocriptine) for hyperprolactinemia
Surgical intervention: For anatomical causes such as intrauterine adhesions (Asherman syndrome) or tumors
Psychotherapy: As a complementary measure in eating-disorder-related amenorrhea

If left untreated, amenorrhea can lead to long-term complications including osteoporosis, infertility, and increased cardiovascular risk. Early medical evaluation is therefore strongly recommended.

References

World Health Organization (WHO): Medical Eligibility Criteria for Contraceptive Use, 5th Edition, 2015.
Klein DA, Poth MA: Amenorrhea: An Approach to Diagnosis and Management. American Family Physician, 87(11):781-788, 2013. PubMed PMID: 23939500.
Gordon CM: Clinical practice. Functional hypothalamic amenorrhea. New England Journal of Medicine, 363(4):365-371, 2010. PubMed PMID: 20660404.

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