Amenorrhea is a medical condition characterized by the absence of menstrual periods in women of reproductive age. There are two types of amenorrhea: primary and secondary.

Primary amenorrhea occurs when a girl has not started her menstrual cycle by the age of 16. On the other hand, secondary amenorrhea is the absence of menstruation for three or more consecutive months in a woman who has previously had regular periods.

Signs and symptoms

The main sign of amenorrhea is the absence of a period.

Women may also experience other symptoms depending on the cause, including:

Excess facial hair
Hair loss
Headache
Lack of breast development
Milky discharge from the breasts
Vision changes

Causes

Amenorrhea is primarily caused by genetic factors, family history, and lifestyle factors. The following factors put women at higher risk:

A family history of amenorrhea or early menopause.
A genetic or chromosomal defect. These can affect your ovary function and menstrual cycle. Turner syndrome is one example.
Severely overweight or underweight.
An eating disorder.
An extreme exercise pattern.
A poor diet.
Stress.

Secondary amenorrhea is caused by pregnancy, breastfeeding, and menopause. There are also other possible causes such as:

Some contraceptive methods, such as pills, injections, or intrauterine devices. These can affect your menstrual cycle during and after use. However, not having your period while using contraceptives does not cause health problems, and should not be a cause of concern.
Some medicines for depression and blood pressure.
Chemotherapy and radiation treatment.
Polycystic ovary syndrome (PCOS).
Fragile X syndrome (caused by the FMR1 gene) or fragile X-associated primary ovarian insufficiency (FXPOI).
Problems with your thyroid or pituitary gland.
Hypothalamic disease.
Uterine scar tissue.

Diagnosis

Consult a gynecologist if you suspect you have amenorrhea. Your doctor will review your health history and perform a physical examination if you have never menstruated. A regular physical and pelvic check can show signs of puberty.

For secondary amenorrhea, doctors often ask to take a pregnancy test. If this is negative, they will do a physical exam and review your health history.

You may be asked to do additional tests to rule out or determine a cause. A karyotype test examines chromosomes. A genetic test looks for the mutated FMR1 gene. Imaging tests can look at your female organs. A blood test can check your:

Thyroid function (thyroid-stimulating hormone, or TSH, levels).
Ovary function (follicle-stimulating hormone, or FSH, and luteinizing hormone, or LH, levels).
Testosterone (“male hormone”) levels, which can detect PCOS.
Estrogen (“female hormone”) levels.

Treatment

Treatment options for amenorrhea vary based on the cause. You may need to make lifestyle changes, such as diet, activity, and stress. Certain hormonal medicines and pills can help trigger a period. Others can help trigger ovulation, such as for PCOS. Hormone therapy may be used to balance out your hormones. Surgery is rare in amenorrhea but may be needed in some cases, such as: