If you miss your monthly period for 3 straight months after having regular cycles for the previous 9 months, you may have secondary amenorrhea. This type of amenorrhea is more common. For instance, primary amenorrhea can result from structural problems with your sex organs. It may be a sign of underdeveloped or malfunctioning ovaries.
Issues with your pituitary or thyroid glands can result in secondary amenorrhea. When working properly, these glands produce the hormones needed for menstruation. Starting, stopping, or changing birth control can also affect your menstrual cycle. It may be a sign of an underlying medical condition that requires treatment.
To diagnose the cause of your missed periods, your doctor will first rule out pregnancy and menopause. Your doctor may perform a pelvic exam. They may also order diagnostic tests, such as urine, blood, or imaging tests, to help them make a diagnosis. To help you manage your mental health, your doctor may also prescribe talk therapy, medications, or other treatments. To treat issues with your thyroid gland, your doctor may prescribe medications like hormone replacements or recommend surgery.
For ovarian cancer, your doctor may recommend a combination of medications, radiation therapy , and chemotherapy.
While missing a period may not seem like a health crisis, it can carry health risks. In most cases, amenorrhea and its underlying causes are treatable. Ask your doctor for more information about your condition, treatment options, and long-term outlook. Poor nutrition as may occur in women who have an eating disorder Overview of Eating Disorders Eating disorders involve a disturbance of eating or of behavior related to eating, typically including Changes in what or how much people eat Measures people take to prevent food from being Mental disorders such as depression Depression A short discussion of prolonged grief disorder.
Obsessions are recurring, persistent, unwanted, anxiety-provoking, intrusive ideas, images, or urges. Antidepressants, antipsychotic drugs, oral contraceptives sometimes , or certain other drugs can cause prolactin levels to increase, as can pituitary tumors and some other disorders. The thyroid gland may cause amenorrhea if it is underactive called hypothyroidism Hypothyroidism Hypothyroidism is underactivity of the thyroid gland that leads to inadequate production of thyroid hormones and a slowing of vital body functions.
Facial expressions become dull, the voice Graves disease is the most common cause of hyperthyroidism Less common causes of secondary amenorrhea include chronic disorders particularly of the lungs, digestive tract, blood, kidneys, or liver , some autoimmune disorders, cancer, HIV infection, radiation therapy, head injuries, a hydatidiform mole overgrowth of tissue from the placenta , Cushing syndrome, and malfunction of the adrenal glands.
Scarring of the uterus usually due to an infection or surgery , polyps, and fibroids can also cause secondary amenorrhea. Genetic disorders, such as Fragile X syndrome Fragile X Syndrome Fragile X syndrome is a genetic abnormality on the X chromosome that leads to intellectual disability and behavior problems. Chromosomes are structures within cells that contain DNA and many Doctors determine whether amenorrhea is primary or secondary.
This information can help them identify the cause. Development of masculine characteristics, such as excess body hair, a deepened voice, and increased muscle size. An impaired sense of smell which may be a symptom of Kallmann syndrome Kallmann syndrome Hypogonadism is decreased production of testosterone, sperm, or both in males. A milky nipple discharge Nipple Discharge Fluid that leaks from one or both nipples is called a nipple discharge.
Each breast has several 15 to 20 milk ducts. A discharge can come from one or more of these ducts. See also Overview Periods have not started by age 15 in girls who are growing normally and have developed secondary sexual characteristics. If girls or women of childbearing age have had menstrual periods that have stopped, they should see a doctor if they have. Such women may have secondary amenorrhea. Doctors always do a pregnancy test when they evaluate women for secondary amenorrhea.
Women may wish to do a home pregnancy test before they see the doctor. Doctors first ask about the medical history, including the menstrual history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of amenorrhea and the tests that may need to be done see table Some Causes and Features of Amenorrhea Some Causes and Features of Amenorrhea Having no menstrual periods is called amenorrhea. Amenorrhea is normal in the following circumstances: Before puberty During pregnancy While breastfeeding read more.
For the menstrual history, doctors determine whether amenorrhea is primary or secondary by asking the girl or woman whether she has ever had a menstrual period. If she has, she is asked how old she was when the periods started and when the last period occurred. She is also asked to describe the periods:.
This information enables doctors to rule out some causes. Information about delayed puberty and genetic disorders in family members can help doctors determine whether the cause is a genetic disorder. Doctors ask about other symptoms that may suggest a cause and about use of drugs, exercise, eating habits, and other conditions that can cause amenorrhea.
During the physical examination, doctors determine whether secondary sexual characteristics have developed. A breast examination is done. A pelvic examination is done to determine whether genital organs are developing normally and to check for abnormalities in reproductive organs.
A milky discharge from both nipples: Possible causes include pituitary disorders and drugs that increase levels of prolactin a hormone that stimulates milk production. Headaches, hearing loss, and partial loss of vision or double vision: Possible causes include tumors of the pituitary gland or hypothalamus.
Development of masculine characteristics, such as excess body hair, a deepened voice, and increased muscle size: Possible causes include polycystic ovary syndrome, tumors that produce male hormones, and use of drugs such as synthetic male hormones androgens , antidepressants, or high doses of synthetic female hormones called progestins. Hot flashes, vaginal dryness, and night sweats: Possible causes include premature menopause, a disorder that causes the ovaries to malfunction, radiation therapy, and use of a chemotherapy drug.
Shakiness tremors with weight loss or sluggishness with weight gain: These symptoms suggest a thyroid disorder. If pregnancy is ruled out, other tests are done based on results of the examination and the suspected cause. If girls have never had a period primary amenorrhea and have normal secondary sexual characteristics, testing begins with ultrasonography to check for birth defects that could block menstrual blood from leaving the uterus. If birth defects are unusual or difficult to identify, magnetic resonance imaging MRI may be done.
Tests are usually done in a certain order, and causes are identified or eliminated in the process. Whether additional tests are needed and which tests are done depend on results of the previous tests. Typical tests include. Blood tests to measure levels of prolactin to check for conditions that cause high levels , thyroid hormones to check for thyroid disorders , follicle-stimulating hormone to check for pituitary or hypothalamus malfunction , and male hormones to check for disorders that cause masculine characteristics to develop.
Imaging tests of the abdomen and pelvis using computed tomography CT , MRI, or ultrasonography to look for a tumor in the ovaries or adrenal glands. Viewing of the uterus and usually fallopian tubes hysteroscopy Hysteroscopy Sometimes doctors recommend screening tests, which are tests that are done to look for disorders in people who have no symptoms.
If women have symptoms related to the reproductive system gynecologic Use of hormones estrogen and a progestin or progesterone to try and trigger menstrual bleeding. For hysteroscopy, doctors insert a thin viewing tube through the vagina and cervix to view the interior of the uterus.
This procedure can be done in a doctor's office or in a hospital as an outpatient procedure. For hysterosalpingography, x-rays are taken after a substance that can be seen on x-rays a radiopaque contrast agent is injected through the cervix into the uterus and fallopian tubes.
Hysterosalpingography is usually done as an outpatient procedure in a hospital radiology suite. Turner syndrome is a genetic disorder. People with this condition may have underdeveloped ovaries and an absence of menstruation. Genital tract defects are structural problems that can cause an absence of menstruation or make it difficult for the menstrual blood to exit the vagina.
The most common female genital tract defect is an imperforate hymen, which is a hymen with no opening that closes off the vagina and does not allow blood to leave it during a period. The pituitary gland releases the hormones that control the menstrual cycle. Issues with the pituitary gland, including those below, may lead to amenorrhea:.
Radiation therapy may also affect cells in the pituitary gland and cause amenorrhea. People who miss three periods in a row but are not pregnant or likely to be entering menopause should see a doctor.
This is especially important if they are experiencing additional symptoms. A doctor will recommend the best course of treatment for amenorrhea after diagnosing its underlying cause. Primary amenorrhea is often due to late puberty , which usually resolves over time. However, a doctor can help determine if there is another underlying cause for periods not beginning. If a hormonal imbalance is responsible, the doctor may prescribe hormonal therapy. If a person has amenorrhea due to rapid weight gain, the doctor is likely to recommend a calorie-controlled diet and exercise.
In cases where amenorrhea develops due to a structural problem, surgery and an individualized treatment plan may be necessary. Most causes of absence of menstruation are treatable. Following the treatment plan that a doctor recommends can help many people with amenorrhea regain a regular menstrual cycle. While occasional changes in the menstrual cycle are not unusual, frequently experiencing two periods in a month may indicate an underlying medical….
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Medically reviewed by Holly Ernst, P.
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