Understanding Amenorrhea: Types, Causes, Symptoms, and Treatment Options

If you haven’t gotten your period in a while, or if your periods were regular and now they’ve stopped, you might be experiencing amenorrhea. While sometimes temporary, amenorrhea can signal underlying health conditions.

This article covers the basics of amenorrhea, including types, causes, diagnosis, treatment, and how it can impact fertility.

What is amenorrhea?

The American College of Obstetricians and Gynecologists (ACOG) defines amenorrhea as the “absence of menstrual periods.” In simpler terms, it means not getting your period for a while. Other sources define amenorrhea as the absence of a menstrual cycle for more than three consecutive cycles.

Amenorrhea isn’t a disease itself, but sometimes it can be a clue that something else is going on.

Types of Amenorrhea

Amenorrhea falls into two main categories:

• Primary amenorrhea: This means a person assigned female at birth (AFAB) hasn’t had their first period (known as menarche) by age 15 (sometimes sources say 16, but doctors often use the age 15 as a guide), even if they’ve experienced other signs of puberty like breast development.

• Secondary amenorrhea: This happens when someone who’s been having regular periods misses them for three months or more.

If your missed periods aren’t caused by things like pregnancy, breastfeeding, or menopause, it’s worth checking in with your doctor to see if there’s another reason behind it.

Causes of Amenorrhea

Potential causes of amenorrhea include:

• Genetic conditions: Conditions like Turner syndrome (where a person has one X chromosome or a variation in their X chromosomes), Androgen Insensitivity Syndrome (where a person’s body doesn’t respond typically to male sex hormones), and gonadal dysgenesis can sometimes cause primary amenorrhea.
• Neurological disorders: Conditions affecting the hypothalamus, pituitary gland (including pituitary tumors), or other brain parts that control the menstrual cycle can lead to primary and secondary amenorrhea
• Structural abnormalities: Problems with the development of the uterus, vagina, or cervix can cause both primary and secondary amenorrhea. This includes things like an absent uterus, a blockage in the vagina, or medical conditions such as Asherman’s syndrome (where scar tissue forms inside the uterus).

• Endocrine disorders: Hormonal imbalances, such as polycystic ovary syndrome (PCOS), thyroid problems (including hyperthyroidism and hypothyroidism), issues with the adrenal glands, and premature ovarian failure or primary ovarian insufficiency (POI), can contribute to both primary and secondary amenorrhea.

• Low body weight: Significant or rapid weight loss, excessive exercise, or eating disorders such as anorexia nervosa can disrupt hormonal balance and lead to secondary amenorrhea.
• Stress: Physical or emotional stress can interfere with the normal functioning of the hypothalamus, leading to hypothalamic amenorrhea, a type of secondary amenorrhea caused by hypothalamic dysfunction.
• Chronic conditions: Conditions such as diabetes, celiac disease, and autoimmune disorders can contribute to secondary amenorrhea.

Additionally, certain medications, including some types of birth control pills, antipsychotics, chemotherapy drugs, and some antidepressants, can also cause amenorrhea.

Diagnosis and Evaluation

If you’re experiencing amenorrhea, your doctor will work with you to find the cause.

Here’s a closer look at what the process might involve:

• Your medical history: Your doctor will ask detailed questions about your periods and any other symptoms, including unusual hair growth (hirsutism), weight changes, acne, headaches, your lifestyle, medications, and your family history.

• Physical examination: This might include checking your weight and blood pressure and looking for signs of hormonal imbalances. Your doctor may also perform a pelvic exam to check for structural issues.
• Blood tests: These help doctors understand your hormone levels. Common tests include:
  • Pregnancy test: This rules out pregnancy as a reason for missed periods.
  • Hormone panel: Looks at levels of the thyroid hormones, prolactin, and the hormones that regulate your menstrual cycle.
  • Androgen levels: Checks for higher than usual levels of male sex hormones, which can point towards conditions like PCOS.
• Imaging tests: If needed, ultrasounds or MRIs provide a detailed picture of your reproductive organs. Your doctor might use them to check for:
  • Structural issues: These can include problems with the uterus, ovaries, or vagina.
  • Tumors: While uncommon, imaging tests can spot tumors on the pituitary gland (such as prolactinomas) or other areas that might affect hormone production, potentially leading to conditions like hyperprolactinemia.
  • Genetic differences: A karyotype, a test examining your chromosomes, can help identify conditions that sometimes cause amenorrhea.

Remember, your doctor will choose the best combination of tests to determine the underlying cause of your amenorrhea.

Treatment Options

The best treatment for amenorrhea depends on the cause.

Here’s an overview of potential treatment options:

Hormonal Therapies 

• Oral contraceptives: These can regulate menstrual cycles, especially when there are hormone imbalances (like in PCOS).
• Estrogen replacement therapy: If primary amenorrhea is caused by low estrogen levels, hormone therapy can help kickstart puberty, trigger periods, and protect against osteoporosis.
• Other hormonal medications: Doctors may prescribe medications to target prolactin, thyroid hormones, or other hormones involved in menstruation.
• Gonadotropins: These are used primarily for fertility treatment and stimulate ovulation but aren’t suitable for everyone.

Lifestyle Changes 

• Weight management: Reaching a healthy weight can restore hormone function with conditions like PCOS or hypothalamic amenorrhea.
• Exercise adjustments: Over-exercising can disrupt your cycle, so finding the right balance is key.
• Stress management: Your doctor might recommend therapies, mindfulness techniques, or gentle exercise to help manage stress.

Surgical Interventions 

• Tumor removal: If a tumor (especially on the pituitary gland) is causing amenorrhea, a surgeon may need to remove it.
• Managing scar tissue: In Asherman’s Syndrome, surgery can sometimes improve uterine function.
• Correcting structural differences: Structural differences in the reproductive organs sometimes prevent menstrual bleeding. Conditions like an imperforate hymen, vaginal septum, or an underdeveloped uterus may require surgical correction.

Impact on Fertility

Amenorrhea can sometimes signal health conditions that make getting pregnant more difficult. Understanding the reason behind your missed periods is important for figuring out your best path to parenthood.

Here’s what you need to know:

• Ovulatory issues: Conditions like PCOS, hypothalamic amenorrhea, or POI can make it harder to conceive naturally because they often disrupt ovulation.
• Other factors: Sometimes, structural problems like Asherman’s Syndrome or anatomical differences in the uterus or vagina can affect your ability to get pregnant or carry a pregnancy to term.

The best way to understand how amenorrhea impacts your individual fertility is to work with a healthcare professional.

Coping Strategies and Support

If you’re dealing with infertility and experiencing amenorrhea, it can bring on a mix of emotions. You might feel worried, frustrated, or even isolated. Know that you’re not alone, and there are ways to cope and find support during this time.

It’s perfectly normal to feel overwhelmed. The missed periods, doctor’s appointments, and uncertainty surrounding your health can take a toll. Let yourself feel whatever emotions come up — there’s no right or wrong way to navigate this.

If having children is something that matters deeply to you, amenorrhea might trigger worries, anxieties, or even feelings of sadness. It’s important to acknowledge these feelings; they’re completely valid.

It can feel isolating when your body doesn’t seem to work how you expect it to. Remember, everyone’s experience with amenorrhea is unique, and you’re not alone.

Strategies for Coping

Here are some strategies to help you cope with the challenges of amenorrhea:

• Reach out for support. Talking to a trusted friend, family member, or therapist can make a big difference. Additional support options include online platforms like BetterHelp, TalkSpace, and Amwell.
• Find online communities. Online forums and support groups connect you with others who understand what it’s like to have amenorrhea. Examples include Facebook groups like the Recover from Hypothalamic Amenorrhea Support Group and The HA Society.
• Focus on self-care. Prioritize sleep, healthy eating, and activities that you genuinely enjoy.
• Be patient with yourself: Getting a proper diagnosis and treatment can take time. Be kind to yourself throughout the process.

Remember: You’re not your diagnosis. There are ways to manage amenorrhea, both physically and emotionally.

Takeaway

Amenorrhea might signal an underlying health issue, but it’s important to remember that it’s often treatable. If you’re experiencing missed periods, reach out to your doctor. They can help you find the answers you need and personalize a plan to get your health back on track.

Understanding the cause of your amenorrhea is the first step towards restoring your periods, improving your overall health, and exploring your fertility options.

A Word from RMA Network

At RMA Network, we’re committed to providing compassionate, personalized care that addresses your physical and emotional well-being throughout the process.

If you have questions about amenorrhea or its impact on fertility, We’re here to support you every step of the way.