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Notes on Women's Health
Notes on Women's Health

Amenorrhea in Women: 6 Facts You Should Know

Amenorrhea is the absence of menstruation of one or more menstrual periods. A woman is considered to have amenorrhea if she has missed at least three periods in a row or if she has not received their first menstrual cycle yet. In other words, amenorrhea is the term for when you do not have periods. Here are six facts about this condition, including possible causes.

Fact 1: There are two types of amenorrhea.

The first major type of amenorrhea, primary amenorrhea, is really a delay in menarche. Menarche is the onset of menstruation at the beginning of puberty. While menarche starts at different ages, it usually begins by the age of 15. If a girl has not had her first period by 15, she is experiencing primary amenorrhea and should be seen by an OB-GYN to determine the cause.

Secondary amenorrhea, on the other hand, is defined by the American College of Obstetricians and Gynecologists (ACOG) as the absence of menses for three or more cycles, after the establishment of regular menses. Simply put, secondary amenorrhea is when you miss your period for at least three months. There are many possible causes of secondary menorrhea which we will discuss below, but you should know that it is a good idea to consult your OB-GYN before a full three months of missed periods.

Fact 2: The most common cause of amenorrhea is not a medical disorder.

As you may have guessed, the top cause of amenorrhea is not a medical disorder. It is pregnancy. For many women, the first sign of pregnancy is a missed period, and a pregnancy test is one of the first diagnostics your doctor will perform when investigating amenorrhea.

Fact 3: Primary amenorrhea does not necessarily indicate a problem.

Some girls get their first period at 11 or 12, or even earlier. While most girls will reach menarche by 15, the failure to have a period by this age does not necessarily mean there is a medical issue. Just as some girls begin to form breasts later than others, every girl reaches menarche in their own time.

Still, primary amenorrhea does need to be evaluated. Sometimes late menarche may run in a family, but your OB-GYN will need to conduct tests to ensure there are no medical issues. These tests may include an ovary function test where important hormone levels like follicle stimulating hormone and luteinizing hormone numbers are measured. A pregnancy test is also a standard diagnostic for primary amenorrhea.

Fact 4: Certain contraceptives can cause amenorrhea.

Pharmaceutical contraceptives, such as birth control pills, injectable contraceptives and intrauterine devices (IUDs) can cause a woman’s period to stop. Since some contraceptives introduce new hormones to a woman’s body, it can affect their menstruation cycle. In some cases, even after a woman stops taking contraceptives, it can take a few weeks for regular menstruation to return. When considering birth control, ask your doctor about any possible side effects to your period.

Fact 5: Your weight can cause secondary amenorrhea.

Women who are overweight, as well as those who are extremely underweight, may experience secondary amenorrhea. Getting back to a healthy weight under the guidance of a physician can help to restore normal periods.

Even women with normal body mass indexes (BMIs) may experience amenorrhea if their body fat percentage is too low. For example, female athletes and competitive bodybuilders can develop amenorrhea due to very low percentages of body fat. The Mayo Clinic states that even being 10 percent below a normal BMI can disrupt regular menstruation cycles. While athletics and exercise are generally healthy, having too little body fat can interfere with hormone production and cause issues with menstruation, fertility, and other functions.

Being overweight is linked to a number of health conditions, including amenorrhea. Being overweight can cause your body to produce excess hormones, including estrogen and testosterone, and result in a disruption of menstruation.

Fact 6: Effective amenorrhea treatment depends on the cause.

Amenorrhea can be successfully treated in many cases, but the type of treatment depends on the cause of the amenorrhea. For instance, birth control pills or hormonal therapy may help to “jump start” your menstrual cycle if you have polycystic ovarian syndrome (PCOS) or primary ovarian insufficiency (POI). Surgery may be necessary in other cases like uterine scarring.

Sometimes amenorrhea does not have a gynecologic cause; a tumor of the pituitary gland is one example. These are non-cancerous tumors that may interfere with the productions of hormones crucial to menstruation. Pituitary tumors are usually treated with a combination of surgery and radiation.

Whatever the ultimate cause of your amenorrhea, treatment begins with an evaluation from your OB-GYN. If you are:

  • missing periods
  • having unusually heavy periods
  • having irregular periods
  • having painful periods

If you have any questions about abnormal bleeding or amenorrhea,  you can schedule a consultation at Dr. Garofalo’s practice by clicking the button below.

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About the Connecticut OBGYN Practice

Dr. John Garofalo, M.D., is a CT OBGYN based in Fairfield County, providing care for Norwalk, Darien, New Canaan, Weston, Rowaytan and the surrounding areas. He has more than 20 years of practice and surgical experience covering many facets of obstetrics and gynecology.

Laury Berkwitt, APRN, is a nurse practitioner specializing in women’s health in Fairfield County, Connecticut. Laury has a passion for providing quality women’s health care in a safe and comfortable manner by creating a trusting patient-practitioner relationship. She has been in practice for more than 10 years, caring for women of all ages.

For more information, go to www.garofaloobygn.com. John Garofalo, MD, and Laury Berkwitt, APRN, can be reached for personal consultations and well woman exams by calling 203.803.1098.