Amenorrhea

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Medical Author:

Lawrence M Nelson, MD, MBA

Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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• Amenorrhea Overview
• Amenorrhea Causes
• Amenorrhea Symptoms
• When to Seek Medical Care
• Amenorrhea Diagnosis
• Amenorrhea Treatment
• Amenorrhea Self-Care at Home
• Amenorrhea Medical Treatment
• Amenorrhea Surgery
• Amenorrhea Follow-up
• Amenorrhea Prevention
• Amenorrhea Prognosis
• Synonyms and Keywords
• Author and Editor
• Read more on Amenorrhea from Healthwise

Amenorrhea Overview

Amenorrhea is the absence of menstrual bleeding and may be primary or secondary.

• Primary amenorrhea is the absence of menstrual bleeding and secondary sexual characteristics (for example, breast development and pubic hair) in a girl by age 14 years or the absence of menstrual bleeding with normal development of secondary sexual characteristics in a girl by age 16 years.
• Secondary amenorrhea is the absence of menstrual bleeding in a woman who had been menstruating but later stops menstruating for three or more months in the absence of pregnancy, lactation (the ability to breastfeed), cycle suppression with systemic hormonal contraceptive (birth control) pills, or menopause.

For a woman to have regular menstrual cycles, her hypothalamus, pituitary gland, ovaries, and uterus should all be functioning normally. The hypothalamus stimulates the pituitary gland to release follicle-stimulating hormone (FSH) and luteinizing hormone (LH). FSH and LH cause the ovaries to produce the hormones estrogen and progesterone. Estrogen and progesterone are responsible for the cyclical changes in the endometrium (uterine lining), including menstruation. In addition, a woman’s genital tract should be free of any abnormalities to allow the passage of menstrual blood.

Amenorrhea Causes

Amenorrhea can result because of an abnormality in the hypothalamic-pituitary-ovarian axis, anatomical abnormalities of the genital tract, or functional causes.

Hypothalamic causes

• Craniopharyngioma (a brain tumor near the pituitary gland)
• Teratoma (a tumor made up of a mixture of tissues)
• Sarcoidosis (a chronic disease of unknown cause characterized by the formation of nodules in different parts of the body)
• Kallmann syndrome (deficiency of gonadotropins, which are hormones capable of promoting growth and function of reproductive organs)
• Nutritional deficiency
• Low body weight or growth delay

Pituitary causes

• Prolactinemia (high blood levels of prolactin, a hormone that stimulates secretion of milk from the breasts during breastfeeding) - possibly caused by prolactinoma (a tumor of the pituitary gland secreting the hormone prolactin)
• Other pituitary tumors (for example, Cushing syndrome, acromegaly, or thyroid-stimulating hormone)
• Postpartum pituitary necrosis (death of pituitary cells after a woman delivers a baby)
• Autoimmune hypophysitis (cells of the pituitary gland destroyed by the body’s own defense system)
• Pituitary radiation
• Sarcoidosis

Ovarian causes

• Anovulation (lack of the release of an egg)
• Hyperandrogenemia (high blood levels of male hormones)
• Polycystic ovary syndrome (hormonal disorder affecting women of reproductive age)
• Premature ovarian failure
• Turner syndrome (a genetic disorder characterized by underdeveloped ovaries, absence of menstrual onset, and short stature)
• Pure gonadal dysgenesis (defective development of the ovary)
• Autoimmune oophoritis (cells of the ovaries destroyed by the body’s own defense system)
• Fragile X premutation
• Radiation or chemotherapy
• Galactosemia (an inherited disorder in which galactose, a type of sugar, accumulates in the blood)
• Anatomical abnormalities of the genital tract
• Intrauterine adhesions (the opposing surfaces of the uterine cavity stick together)
• Imperforate hymen (a hymen in which there is no opening, the membrane completely closes off the vagina)
• Transverse vaginal septum (a dividing wall or membrane in the vagina)
• Aplasia (absence of an organ or tissue) of the vagina, the cervix, or the uterus

Functional causes

• Anorexia/bulimia
• Chronic diseases (for example, tuberculosis)
• Excessive weight gain or weight loss
• Malnutrition
• Depression or other psychiatric disorders
• Recreational drug abuse
• Psychotropic drug use (drugs prescribed to stabilize or improve mood, mental status, or behavior)
• Excessive stress
• Excessive exercise
• Cycle suppression with systemic hormonal contraceptive (birth control) pills