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A woman who has amenorrhea has either never had a menstrual period or has stopped having periods.

What is going on in the body?

• Primary amenorrhea is not having had a period by age 16.
• Secondary amenorrhea is the absence of periods in a woman who previously had regular menstrual cycles.

To have a period, a woman must have a normal, healthy:

• uterus, cervix (opening to the uterus), vagina, and ovaries
• pituitary gland, a structure in the brain that produces hormones to stimulate the ovaries to produce sex hormones
• hypothalamus, a structure within the skull that controls much of the body's hormone production

An abnormality in any of these may keep a woman from having a period.

What are the signs and symptoms of the condition?

Amenorrhea is not a disease. It is a symptom of any of a variety of health conditions.

Because it is often caused by a hormone imbalance, other symptoms may also be present, including:

• weight gain
• excess body and facial hair
• breast milk secretion
• changes in sex drive
• acne

What are the causes and risks of the condition?

Primary amenorrhea is usually due to late puberty rather than to any permanent condition. The reason for this delay is generally not known, though it may be a family trait.

• a genetic disorder, such as Turner's syndrome
• a hormonal problem, such as an improperly functioning thyroid gland

• breastfeeding
• birth control pills
• the birth control shot, such as medroxyprogesterone acetate
• levonorgestrel implants

A woman's periods may not start up again for a while after she stops using birth control pills, shots or implants. Usually, periods will start again within 3 to 6 months.

• depression
• emotional stress
• poor nutrition
• drugs, such as tranquilizers or antidepressants
• rapid weight loss or gain
• chronic systemic illnesses, such as kidney failure or cancer
• too much exercise
• recent surgery
• a hormonal imbalance, such as polycystic ovary syndrome (PCOS)

What can be done to prevent the condition?

• avoid smoking and alcohol or substance abuse
• maintain a healthy weight by adjusting her diet
• try to balance work and recreation
• lower her stress levels

If this seems too difficult, she should ask for guidance from friends, family, or healthcare professionals.

How is the condition diagnosed?

• a pregnancy test
• hormone tests
• special blood tests if a girl has not developed breasts or pubic hair by age 14
• blood tests if a girl or woman has breast discharge, headaches, vision changes, too much body hair or weight

• HCG hormone, which is a marker for pregnancy
• follicle-stimulating hormone (FSH), which is important in regulating the menstrual cycle
• estradiol level, the main estrogen in the body
• thyroid function
• prolactin, a hormone associated with certain tumors or thyroid gland abnormalities
• chromosome abnormalities that may prevent menstruation

Some tumors of the pituitary gland may cause elevated prolactin levels. Special X-rays of the head can show tumors in the pituitary.

What are the long-term effects of the condition?

Long-term amenorrhea and estrogen-deficiency may raise a woman's risk of excess bone loss and osteoporosis. This makes bones more likely to break. A woman who wishes to become pregnant may be resistant to drugs that help induce ovulation.

• obesity
• excess face and body hair
• acne
• infertility
• ovarian cysts, or fluid-filled sacs
• a higher risk of uterine cancer

What are the risks to others?

There are no risks to others.

What are the treatments for the condition?

If amenorrhea has lasted less than 6 months, a woman may not need treatment unless a related problem is suspected, or abnormalities are seen:

• in her hormone levels
• on X-ray or ultrasound

Depending on the cause of amenorrhea, treatment varies. Diet and exercise generally correct abnormal periods due to obesity. Stress management and not exercising excessively also helps.

• birth control pills
• hormone therapy (HT) if she has reached menopause
• short-term oral progesterone pills or ovulation-inducing agents, such as clomiphene, for infertility

• induce a period
• prevent bone loss

• tumors
• ovarian cysts
• defects in the uterus or vagina

Rarely, surgery is done when chromosome abnormalities are found.

What are the side effects of the treatments?

• breast tenderness
• nausea
• headaches
• PMS symptoms
• abdominal bloating

Occasionally, more serious side effects can occur with hormone therapy including blood clots, liver tumors, and endometrial cancer. Though these are quite rare, it is important for women to discuss the risks and benefits of hormone therapy with their healthcare professional.

• hot flashes
• headaches
• ovarian cysts
• mid-cycle pain

What happens after treatment for the condition?

When a younger woman has amenorrhea, normal periods often resume within a few years. Most women who are diagnosed and treated early can avoid surgery by taking hormones. If a woman wishes to become pregnant and not ovulating is the only infertility problem facing the couple, a success rate of 70% to 80% is possible.

After a woman stops taking birth control pills, she may not experience a period for 2 to 3 months, or sometimes up to or more than a year. If an unusual stress or illness has temporarily stopped a woman's periods, the problem will usually resolve on its own. It may recur at a later date.

How is the condition monitored?

• discuss any medicines or supplements she is taking
• keep a record of periods, marking down length, days between cycles, frequency, and flow patterns
• find out if there is a family history of infertility, ovarian cysts, or irregular cycles