Amenorrhea means not menstruating or having a period. There are two types of amenorrhea: primary and secondary. When a girl reaches age 16 and has not had a period, she may have primary amenorrhea. When a woman who has been having periods misses three in a row, she is considered to have secondary amenorrhea. Amenorrhea is expected in certain circumstances, including during pregnancy, lactation, and menopause. Secondary amenorrhea is more common than primary amenorrhea.

Amenorrhea is a sign of another condition, not a disease itself. Many things can cause it, including low body weight, hormonal imbalances, stress, and problems with the pituitary gland. Usually, the underlying condition is not serious.

Causes of Amenorrhea

Both primary and secondary amenorrhea can have several causes.

Primary amenorrhea

  • Lack of reproductive organs, such as uterus, cervix, or vagina
  • Problems with the pituitary gland
  • Anorexia
  • Stress
  • Too much exercise
  • Abnormal chromosones
  • Malnutrition

Secondary amenorrhea

  • Pregnancy or breastfeeding
  • Polycystic ovaries
  • Using some types of birth control
  • Taking some types of medicines, such as corticosteroids
  • Hormone imbalance
  • Low body weight
  • Too much exercise
  • Thyroid problems
  • Pituitary gland tumor
  • Stress
  • Premature menopause (menopause before age 40)
  • Malnutrition
  • Autoimmune diseases

Amenorrhea Symptoms

Symptoms of primary amenorrhea may include:

  • Headaches
  • Abnormal blood pressure
  • Vision problems
  • Acne
  • Unwanted hair growth

Symptoms of secondary amenorrhea may include:

  • Nausea
  • Swollen breasts
  • Headaches
  • Vision problems
  • Being very thirsty
  • Goiter (an enlarged thyroid gland)
  • Darkening skin

Hot flashes, mood changes, depression, and vaginal dryness are common with estrogen deficiency.

Amenorrhea Treatment

Your doctor will determine which treatment is right for you based on the cause of your amenorrhea. Treatments include hormone therapy, psychological counseling and support, and surgery, among others.

Drug Therapies

Your health care provider may suggest the following:

  • Birth control pills or hormones to help you start menstruating.
  • Estrogen replacement for low levels of estrogen caused by ovarian problems, hysterectomy, or menopause. Women with an intact uterus should get estrogen plus progesterone. Estrogen, or hormone replacement therapy (HRT), has both benefits and risks. Post-menopausal women who take HRT have higher risk of breast cancer, stroke, heart disease, and blood clots in the lungs. However, for some younger women, the benefits may outweigh the risks. Talk to your doctor to decide what is best for you.
  • Progesterone to treat ovarian cysts and some problems with the uterus.
  • Metformin to treat cysts in the ovaries and support ovulation.