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Amenorrhea
Absence of Menstruation
Amenorrhea is the medical term for the lack of a menstrual period. This can be a young woman who has not had a period by age 16 or a woman with regular periods who experiences an absence of more than three cycles. Amenorrhea is not a disease, but it can be a symptom of another condition. Learn what causes amenorrhea and how to treat it.
Uterus
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Menstruation
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Amenorrhea (pronounced ey-men-uh-REE-uh or uh-men-uh-REE-uh) is the medical term for the lack of a menstrual period. Amenorrhea is not a disease, but it can be a symptom of another condition.
Primary amenorrhea occurs when a girl has not had her first period by age 16. Secondary amenorrhea describes women who experience an absence of more than three cycles after having regular periods.
Source: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NIH)
Estrogen Levels and Peak Fertility During the Menstrual Cycle
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Amenorrhea is the loss or lack of menstrual periods. If a teenager does not have a menstrual period by age 16, it is called primary amenorrhea. Secondary amenorrhea occurs when a woman stops having periods for three or more months in a row after having regular periods in the past.
The main symptom of amenorrhea is missing or not starting the menstrual period. Depending on the cause of amenorrhea, other symptoms could include:
Pregnancy is the most common cause of amenorrhea. However, there are other reasons women may stop having periods, including:
A teenager may not get her first period for several reasons, including:
Missing periods may be a sign that something is not normal. It is important to ask a healthcare provider if you are concerned about missing one or more periods.
The type of treatment depends on the cause of amenorrhea. If weight, stress, or physical activity is causing the amenorrhea, lifestyle changes may help. Medications are often used to treat other causes of amenorrhea. Hormones, such as those found in birth control pills, may be used to protect the uterus when lifestyle factors cause amenorrhea. It is important to talk to your healthcare provider about treatment options.
Source: U.S. Department of Health and Human Services
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Amenorrhea is the absence of a menstrual period.
Amenorrhea is sometimes categorized as:
Having regular periods is an important sign of overall health. Missing a period, when not caused by pregnancy, breastfeeding, or menopause, is generally a sign of another health problem. If you miss your period, talk to your health care provider about possible causes, including pregnancy.
Source: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
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Cross Section of Thin Female / Cross Section of Obese Female Body
According to the American Society for Reproductive Medicine, amenorrhea that is not caused by pregnancy, breastfeeding, or menopause occurs in a small percentage (less than 5%) of women during their lifetime.
The risk factors for amenorrhea include:
Source: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
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Amenorrhea is often a sign of another health problem rather than a disease itself, and it can happen for many reasons. It can occur as a natural part of life, such as during pregnancy or breastfeeding. It can also be a sign of a health problem, such as polycystic ovary syndrome (PCOS). Because amenorrhea is associated with health conditions that are also linked to infertility, understanding amenorrhea is an important part of NICHD's research on infertility and fertility.
Primary amenorrhea (failure of menses to occur by age 16) can result from two main causes:
In rare cases, physical problems—such as missing reproductive organs or blockage of reproductive passageways—can also lead to primary amenorrhea. Missing portions of the reproductive tract can cause endocrine disruptions and may combine with hypothalamic or pituitary problems to prevent menstruation. Blockages may also prevent menstrual bleeding, making it seem like a girl has primary amenorrhea, even if her menstrual cycles are actually normal.
Secondary amenorrhea (missing three menstrual periods in a row or not having periods for at least 6 months after menstruating normally) can result from various causes, such as:
Source: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
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Missing a period is the main sign of amenorrhea.
Depending on the cause, a woman might have other signs or symptoms as well, such as:
Source: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
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If you have had regular periods or if there is any chance you may be pregnant, check with your health care provider about a missed period right away.
If you are just beginning to menstruate, keep in mind that it may take several months for your menstrual cycle to become regular. As you age, the time from the beginning of one cycle to the beginning of the next will likely range from 21 to 35 days, but your periods should become more regular over time.
See your health care provider right away if:
Source: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
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A health care provider will usually ask a series of questions to begin diagnosing amenorrhea, including:
If you are older than 16 and have never had a period, your health care provider will do a thorough medical history and physical exam, including a pelvic exam, to see if you are experiencing other signs of puberty. Depending on the findings and on your answers to the questions above, other tests may be ordered to determine the cause of your amenorrhea.
If you are sexually active, your health care provider will likely order a pregnancy test. He or she will also perform a complete physical exam, including a pelvic exam.
You should contact your health care provider as soon as possible after you miss a period.
Your health care provider might use several of these tests to attempt to diagnose the cause of amenorrhea. In some cases, no specific cause for the amenorrhea can be found. This situation is called idiopathic (pronounced id-ee-uh-PATH-ik) amenorrhea.
Source: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
Pelvic Exam
Also called: Pelvic Examination, Gynecological Exam
A pelvic exam is a doctor's visual and physical examination of a woman's reproductive organs. The exam may be performed as part of a regular checkup or can be done to investigate symptoms such as abnormal bleeding, unusual vaginal discharge, or pain. Pelvic exams are also done during pregnancy check-ups.
Pelvic Ultrasound - Female
Also called: Gynecological Scan, Gynecologic Ultrasound, Female Pelvic Scan, Female Pelvic Sonography, Transabdominal Female Pelvic Ultrasound, Transvaginal Ultrasound, Endovaginal Ultrasound
A female pelvic ultrasound is a test that uses an ultrasound machine to assess the size, shape, and location of the organs and tissues inside a woman’s pelvis, including the uterus, cervix, fallopian tubes, ovaries, vagina, and bladder.
Thyroid Tests
Also called: Thyroid Function Tests, Thyroid Studies, Thyroid Panel
Thyroid tests check how well your thyroid is working. They are also used to diagnose and help find the cause of thyroid diseases such as hyperthyroidism and hypothyroidism. Thyroid tests include blood tests and imaging tests.
TSH (Thyroid-Stimulating Hormone) Test
Also called: TSH, Thyroid-Stimulating Hormone, Thyrotropin
The test measures the amount of thyroid-stimulating hormone (TSH) in a sample of your blood. TSH is made in the pituitary gland and stimulates the release of thyroid hormone. If your TSH levels are too high or too low, it can indicate a thyroid disorder.
Reverse Triiodothyronine Test
Also called: Reverse T3, rT3
Reverse triiodothyronine (T3) is a biologically inactive thyroidal hormone that helps save energy in a stressful condition. Testing for rT3 allows doctors to assess the function of thyroidal gland if the symptoms of thyroidal disorder appear.
Triiodothyronine (T3) Tests
Also called: T3 Test, T3 Free and Total
This test measures triiodothyronine (T3) in your blood. Your thyroid gland makes T3. T3 plays an important role in the body's control of metabolism (the many processes that control the rate of activity in cells and tissues). The test is mainly used to diagnose hyperthyroidism.
Triiodothyronine Uptake Test
Also called: T3 Uptake, T3U, T3 Resin Uptake, T3RU, Thyroid Hormone-binding Ratio, THBR
3 uptake test is an indirect way of evaluating the levels of thyroxine-related protein and thyroid hormones. This test is used together with other thyroid tests to assess the function of your thyroid gland in case of suspected disorder.
Thyroxine Test
Also called: Thyroxine Screen, Tetraiodothyronine
This test measures the level of thyroxine (T4) in the blood. T4 is the main hormone secreted into the bloodstream by the thyroid gland. Too much or too little T4 can indicate thyroid disease.
Thyroxine-Binding Globulin Test
Also called: TBG
This test measures the amount of thyroxine-binding globulin (TBG) in a sample of your blood. It is used to assess thyroid gland function and to help diagnose thyroid disorders.
Thyroid Peroxidase Antibody Test
Also called: TPO Ab, Thyroperoxidase Ab, Antimicrosomal Antibody, Antithyroid Microsomal Antibody, Anti-TPO antibody
Thyroid peroxidase (TPO) antibodies are proteins that mistakenly attack the thyroid gland, potentially leading to damage, long-term inflammation (thyroiditis), and disruption of thyroid function.
Thyroglobulin Test
Also called: TGB, Thyroglobulin Tumor Marker
A thyroglobulin test measures the level of thyroglobulin in your blood. Thyroglobulin is a protein made by your thyroid. The test is mostly used to find out if thyroid cancer treatment has worked.
Thyroglobulin Antibody Test
Also called: Antithyroglobulin Antibody, TGAb
Thyroglobulin is a protein that helps control metabolic functions and production of hormones T3 and T4 in the thyroid gland. Thyroglobulin antibodies are proteins that mistakenly attack the gland, potentially leading to damage, long-term inflammation (thyroiditis) and disruption of thyroid function.
Thyroid-Stimulating Immunoglobulin Test
Also called: TSI, Human Thyroid Stimulator, HTS, Long-acting Thyroid Stimulator, LATS
Thyroid-stimulating immunoglobulins (TSIs) are antibodies that mistakenly attack and overstimulate the thyroid gland, potentially leading to damage, long-term inflammation (thyroiditis) and disruption of thyroid function.
Calcitonin Test
Also called: Thyrocalcitonin, Human Calcitonin, hCT
A calcitonin test checks the level of calcitonin, a thyroid hormone, in your blood. Calcitonin helps control the level of calcium in your blood. The test is mainly used to help diagnose and monitor medullary thyroid cancer.
Follicle-Stimulating Hormone (FSH) Test
Also called: FSH, FSH Levels, Follicle-Stimulating Hormone, Follitropin, Pituitary Gonadotropin
This test measures the level of follicle-stimulating hormone (FSH) in the blood. FSH plays an important role in sexual development and function. FSH levels that are too high or too low can cause health problems for men and women and delayed or early puberty in children.
Luteinizing Hormone (LH) Blood Test
Also called: LH Test, Luteinizing Hormone, Lutropin, Interstitial Cell Stimulating Hormone, ICSH
This test measures the level of luteinizing hormone (LH) in the blood. LH plays an important role in sexual development and functioning. Levels that are too high or too low can cause health problems for men and women, and delayed or early puberty in children.
Free Androgen Index
Also called: FAI, Testosterone/SHBG Ratio
Androgens are “male” sex hormones that can be found in both men and women. They are responsible for the onset of sexual differentiation in males and females and the development of secondary male physical characteristics. This test gives an approximate of free testosterone levels in the blood, by measuring and comparing the total testosterone and sex...
FMR1 Genetic Test
Also called: FMR1 DNA Test, Fragile X DNA Testing
Mutations (changes) in the FMR1 gene on the X chromosome causes fragile X-associated disorders, including Fragile X syndrome, which is an inherited disease of the nervous system that causes severe intellectual disability, developmental delay, and other emotional problems.
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Ovarian Reserve Profile
Also called: Ovarian Reserve Testing, ORT, Fertility Testing - Female, ReproSURE™
The Ovarian Reserve Profile comprises several tests that are performed to assess a woman’s ovarian reserve (egg supply). This indicates the woman’s fertility potential, and it’s usually ordered as part of an in vitro fertilization work-up.
Estradiol Test
Estradiol (E2) is a hormone that belongs to a group of steroids called estrogens. E2 is produced in the ovaries of women and in the testicles of men. This test is useful to assess hormonal unbalances that affect the development of sexual characteristics in both males and females.
Inhibin B Test
Inhibin is a hormone produced by the ovaries and testes. There are two types of inhibin, which are termed inhibin A and inhibin B. Abnormal levels of the inhibin B hormone can be related to infertility, ovarian cancer, low production of sperm, and several other conditions.
Clomiphene Citrate Challenge Test
Also called: CCCT, Clomid® Challenge Test
The Clomiphene Citrate Challenge Test (CCCT) measures certain hormones in a woman’s blood before and after taking the fertility drug clomiphene citrate. This is done to estimate her supply of ovules (eggs) and predict the success rate of pregnancy with in vitro fertilization (IVF).
Antral Follicle Count
Also called: AFC
The Antral Follicle Count (AFC) is a painless and risk-free test in which a transvaginal ultrasound is performed to assess a woman’s ovarian reserve (egg supply). This indicates the woman’s fertility potential, and it’s usually ordered as part of an in vitro fertilization work-up.
Karyotype Test
Also called: Chromosome Analysis, Chromosome Karyotype, Chromosome Studies, Chromosome Testing, Karyotyping, Karyotype Genetic Test
A karyotype test is a type of genetic testing. It looks at the size, shape, and number of your chromosomes. Chromosomes are parts of cells that contain genes. If the number or structure of your chromosomes is not normal, it can indicate a genetic disease.
Hysteroscopy
Also called: Uteroscopy
A hysteroscopy is a procedure that examines the cervix and uterus. It uses a hysteroscope, a thin tube with a camera, which is inserted through the vagina. The camera transmits images to a video screen. It helps diagnose and treat uterine disorders.
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The treatment for amenorrhea depends on the underlying cause, as well as the health status and goals of the individual.
If primary or secondary amenorrhea is caused by lifestyle factors, your health care provider may suggest changes in the areas below:
Be aware of changes in your menstrual cycle and check with your health care provider if you have concerns. Keep a record of when your periods occur. Note the date your period starts, how long it lasts, and any problems you experience. The first day of bleeding is considered the first day of your menstrual cycle.
For primary amenorrhea, depending on your age and the results of the ovary function test, health care providers may recommend watchful waiting. If an ovary function test shows low follicle-stimulating hormone (FSH) or luteinizing hormone (LH) levels, menstruation may just be delayed. In females with a family history of delayed menstruation, this kind of delay is common.
Primary amenorrhea caused by chromosomal or genetic problems may require surgery. Women with a genetic condition called 46, XY gonadal dysgenesis have one X and one Y chromosome, but their ovaries do not develop normally. This condition increases the risk for cancer developing in the ovaries. The gonads (ovaries) are often removed through laparoscopic surgery to prevent or reduce the risk of cancer.
Treatment for secondary amenorrhea, depending on the cause, may include medical or surgical treatments or a combination of the two.
Common medical treatments for secondary amenorrhea include:
In general, medications are safe, but they can have side effects, some of which may be serious. You should discuss side effects and risks with your health care provider before deciding on any specific medical treatment.
Surgical treatment for amenorrhea is not common, but may be recommended in certain conditions. These include:
Pituitary tumor. Medications may be recommended to shrink the tumor. If this does not work, surgery may be necessary to remove the tumor. Pituitary tumors are not cancerous, but they can cause problems as they grow. Pituitary tumors can put pressure on surrounding blood vessels and nerves such as the optic nerve and may result in loss of vision.
Most of the time, pituitary tumors are removed through the nose and sinuses. Radiation therapy may be used to shrink the tumor, either in combination with surgery or, for those who cannot have surgery, by itself.
Source: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
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An important part of the menstrual cycle is the production of the hormone estrogen. Estrogen also plays a role in bone health. If amenorrhea is caused by low estrogen or problems with estrogen production, a woman may be at risk for loss of bone mass.
Some common causes of estrogen deficiency are excessive exercise and eating disorders. These can have a negative effect on bone density. Adolescent girls in particular need a combination of calcium, vitamin D, and physical activity to build strong bones during this critical time. Years ago, researchers found that girls with amenorrhea who diet are at risk for low bone density and that this condition increases their risk for osteoporosis later in life.
Amenorrhea that results from Fragile X-associated primary ovarian insufficiency (FXPOI) also increases the risk for osteoporosis. It is important to see your health care provider as early as possible to begin investigating the cause of amenorrhea. According to one study, two-thirds of adolescent girls who reported FXPOI also had osteopenia, an early stage of osteoporosis, at their first visit.
Source: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
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Yes, you can still get pregnant even if you do not have regular periods. Although some of the conditions that cause amenorrhea can also contribute to infertility, there is still a chance for pregnancy.
In addition, certain medical treatments for amenorrhea can increase the chances of pregnancy. If you do not want to become pregnant and you have amenorrhea, you should use contraception to prevent pregnancy.
Some women believe that they cannot get pregnant if they are breastfeeding and they aren't having menstrual periods. Unless a woman has gone through menopause, there is always the chance that she could get pregnant.
If you are breastfeeding and want to prevent pregnancy, you should use a form of birth control to do so.
Source: Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)
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