The term also applies to people who have not started their period by the age of 16, which is called primary amenorrhea. Secondary amenorrhea occurs in people who have missed 3 months of periods. This article explores possible reasons for an absence of menstruation.
It also covers when to see a doctor and the treatment options. A period, or menstrual bleeding, is the womb lining exiting the body. Amenorrhea is the absence of menstrual bleeding. During the menstrual cycle, hormones cause an ovary to produce and release an egg. The ovary also releases the hormones estrogen and progesterone. Estrogen primarily causes the womb lining to thicken, while progesterone prepares the womb for the implantation of an egg.
If no sperm fertilizes the egg, pregnancy does not occur, and the egg dissolves. The levels of estrogen and progesterone decline, and the womb lining falls away. It leaves the body through the vagina, giving the person a period. If a female reaches the age of 16 without any periods, this is called primary amenorrhea. Sometimes a person will have no menstrual bleeding for more than three cycles despite having had regular periods until then.
If there is no natural cause for this, such as pregnancy, they have secondary amenorrhea. Secondary amenorrhea occurs in approximately 3—5 percent of adult women. Natural causes of amenorrhea include pregnancy, breastfeeding, and menopause. In these cases, there is no need to see a doctor. When a person has regular menstrual bleeding, this means that the ovaries, uterus, hypothalamus, and pituitary gland are working well.
Next, tests are also done to see whether the pituitary gland is producing two vital hormones called follicle stimulating hormone FSH and luteinizing hormone LH. The treatment for amenorrhea will depend on what is causing it, Dr. Treatment for polycystic ovary syndrome can vary, but a woman trying to get pregnant may be given medication to help her ovulate. If she is overweight, she may be told to lose weight. A woman who has a very low body weight will be told to increase her body fat, he says.
In other words, she needs to gain weight. Treatment for anorexia may require inpatient care at a specialized facility which includes intensive therapy, nutrition education and medical care. The primary symptom of secondary amenorrhea is missing several menstrual periods in a row. Women may also experience:. Call your doctor if you have missed more than three consecutive periods, or if any of your symptoms become severe. Your doctor will first want you to take a pregnancy test to rule out pregnancy.
Your doctor may then run a series of blood tests. These tests can measure the levels of testosterone, estrogen, and other hormones in your blood. Your doctor may also use imaging tests to diagnose secondary amenorrhea. MRI, CT scans , and ultrasound tests allow your doctor to view your internal organs.
Your doctor will be looking for cysts or other growths on your ovaries or in the uterus. Learn more: Ovarian cysts ». The treatment for secondary amenorrhea varies depending on the underlying cause of your condition. Hormonal imbalances can be treated with supplemental or synthetic hormones. Your doctor may also want to remove ovarian cysts, scar tissue, or uterine adhesions causing you to miss your menstrual periods. Your doctor may also recommend making certain lifestyle changes if your weight or exercise routine is contributing to your condition.
Ask your doctor for a referral to a nutritionist or dietitian, if necessary. These specialists can teach you how to manage your weight and physical activity in a healthy manner. Low estrogen is typically seen in younger women and women approaching menopause. 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.
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:. What causes primary amenorrhea? Primary amenorrhea failure of menses to occur by age 16 can result from two main causes: Chromosomal or genetic abnormalities can cause the ovaries to stop functioning normally.
Turner syndrome , a condition caused by a partially or completely missing X chromosome, and androgen insensitivity syndrome, often characterized by high levels of testosterone, are two examples of genetic abnormalities that can delay or disrupt menstruation.
Conditions such as eating disorders, excessive exercise, and extreme physical or psychological stress or a combination of these factors can also disrupt the normal functioning of the hypothalamus or pituitary gland, delaying the onset of menstruation.
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