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Amenorrhea is a menstrual condition characterized by absent menstrual periods for more than three monthly menstrual cycles, and may be classified as primary or secondary. Primary amenorrhea occurs when menstruation fails to start puberty; secondary amenorrhea is due to some physical cause and usually occurs after normal periods have begun but become increasingly irregular or absent. It is one of many conditions sometimes caused by hormone irregularities, which can be labeled by the more general term, Dysfunction Uterine Bleeding - DUB.
Ovulation abnormalities are usually the cause of very irregular or frequently missed menstrual periods. If a young woman has not started to menstruate by the age of 16 then a birth defect, anatomical abnormality, or other medical condition may be suspected.
Diagnosis & Tests
Diagnosis begins with a gynecologist evaluating a patient's medical history and a complete physical examination including a pelvic examination. A diagnosis of amenorrhea can only be certain when the physician rules out other menstrual disorders, medical conditions, or medications that may be causing or aggravating the condition. In addition, a diagnosis of amenorrhea requires that a woman has missed at least three consecutive menstrual cycles, without being pregnant. Young women who have not had their first menstrual period by the age of 16 should be evaluated promptly: making an early diagnosis and starting treatment as soon as possible is very important.
Treatment & Prevention
Specific treatment for amenorrhea will be determined by your doctor based on what is believed to be the cause. Most of the conditions that cause secondary amenorrhea will respond to treatment. In most cases, doctors will induce menstruation in non-pregnant women who have missed two or more consecutive menstrual periods, because of the danger posed to the uterus if the non-fertilized egg and endometrium lining are not expelled. Without this monthly expulsion, the risk of uterine cancer increases.
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Signs, symptoms & indicators of Amenorrhea:
Conditions that suggest Amenorrhea:
Risk factors for Amenorrhea: | | | | | Habits |  The Effects Of Overtraining | Many young female athletes in training experience absent menstrual cycles due to low body fat content. Exercising women with regular menstrual cycles and amenorrheic women who do not exercise excessively demonstrate a clear diurnal rhythm of leptin levels. Exercising women with amenorrhea lose this normal rhythm, which raises the possibility that this cycle is important for the maintenance of reproductive function. Leptin levels normally rise during the afternoon and reach a peak in the early hours of the morning, then decline towards dawn.
For some women, simply explaining the need for adequate calorific intake to match energy expenditure results in increased intake and/or reduced exercise, and their menses resume. For those women in whom no other cause of amenorrhea can be found, but who are unable or unwilling to either increase food intake or decrease the amount of exercise, estrogen replacement therapy is strongly indicated. Appropriate therapy consists of any estrogen replacement regimen that includes endometrial protection. |
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Hormones |
Hypothyroidism |
Metabolic |
Hemochromatosis (Iron overload)
Problems Caused By Being Overweight| | Women who are obese often experience amenorrhea as a result of excess fat cells interfering with the process of ovulation. |
Problems Caused By Being Underweight
 Anorexia / Starvation Tendency| | Women with anorexia and/or bulimia often experience amenorrhea as a result of maintaining a body weight that would be too low to sustain a pregnancy. As a result, as a form of protection for the body, the reproductive system shuts down because it is severely malnourished. |
Bulimic Tendency| | Women with anorexia and/or bulimia often experience amenorrhea as a result of maintaining a body weight that would be too low to sustain a pregnancy. As a result, as a form of protection for the body, the reproductive system shuts down because it is severely malnourished. |
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Nutrients |
Zinc Requirement |
Supplements and Medications |
Counter-indicators:
 Progestin use (confirmed)| | Injected progestins have been the standard form of injected contraceptive - and are very effective - but they can have severe effects on the menstrual cycle. Like other progestin contraceptives, Depo-Provera prevents pregnancy by halting ovulation, thickening the cervical mucus, and stopping the implantation of fertilized eggs in the uterine lining. |
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Tumors, Malignant |
Brain Tumor |
Uro-Genital |
Polycystic Ovary Syndrome (PCOS)| | In many women with polycystic ovaries, menstruation begins at the normal age. After a year or two of regular menstruation, the periods become highly irregular and then infrequent. |
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Amenorrhea suggests the following may be present: | | | | | Habits | The Effects Of Overtraining| | Many young female athletes in training experience absent menstrual cycles due to low body fat content. Exercising women with regular menstrual cycles and amenorrheic women who do not exercise excessively demonstrate a clear diurnal rhythm of leptin levels. Exercising women with amenorrhea lose this normal rhythm, which raises the possibility that this cycle is important for the maintenance of reproductive function. Leptin levels normally rise during the afternoon and reach a peak in the early hours of the morning, then decline towards dawn.
For some women, simply explaining the need for adequate calorific intake to match energy expenditure results in increased intake and/or reduced exercise, and their menses resume. For those women in whom no other cause of amenorrhea can be found, but who are unable or unwilling to either increase food intake or decrease the amount of exercise, estrogen replacement therapy is strongly indicated. Appropriate therapy consists of any estrogen replacement regimen that includes endometrial protection. |
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Metabolic |
Problems Caused By Being Overweight| | Women who are obese often experience amenorrhea as a result of excess fat cells interfering with the process of ovulation. |
Problems Caused By Being Underweight |
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Recommendations and treatments for Amenorrhea:
KEY | | Weak or unproven link | | | Strong or generally accepted link |  | | Proven definite or direct link | | | Very strongly or absolutely counter-indicative |  | | Likely to help |  | | Highly recommended |
GLOSSARY
Amenorrhea
Absence or suppression of menses. Primary amenorrhea is the failure to begin menses by age 16, secondary amenorrhea is tardy menses (from pregnancy, stress, dieting, illness or intensive physical training) in the previously menstruating woman.
Anorexia Nervosa (Anorexia)
An eating disorder characterized by excess control - a morbid fear of obesity leads the sufferer to try and limit or reduce their weight by excessive dieting, exercising, vomiting, purging and use of diuretics. Sufferers are typically more than 15% below the average weight for their height/sex/age and typically have amenorrhea (if female) or low libido (if male). 1-2% of female teenagers are anorexic.
Bulimia Nervosa (Bulimia)
An eating disorder characterized by lack of control - abnormal eating behavior including dieting, vomiting, purging and particularly bingeing that is usually associated with normal weight or obesity (unlike anorexics, who tend to be considerably underweight). The syndrome is associated with guilt, depressed mood, low self-esteem and sometimes with childhood sexual abuse, alcoholism or promiscuity.
Cancer
Refers to the various types of malignant neoplasms that contain cells growing out of control and invading adjacent tissues, which may metastasize to distant tissues.
Dysfunctional Uterine Bleeding (DUB)
Any abnormality of menstruation or bleeding caused by a hormonal disorder. DUB is a diagnosis of exclusion. The following conditions should be ruled out in order to diagnose DUB: endometrial polyps, uterine fibroids, adenomyosis, endometrial or cervical cancer, pelvic infection including endometritis (infection of the lining of the uterus), endometriosis, polycystic ovarian disease, ovarian cyst or tumor, thyroid dysfunction or blood clotting abnormalities. Hormone testing may indicate abnormalities which replacement therapy would then resolve. If the dysfunctional bleeding disappears, then no further testing may be necessary.
Failure to perform sufficient testing may result in an incorrect diagnosis of DUB because the true cause of the abnormal bleeding has been overlooked. A premature diagnosis of DUB may lead to improper and failed treatment. DUB accounts for approximately 20% of all hysterectomies in the U.S.
Estrogen (Oestrogen)
One of the female sex hormones produced by the ovaries.
Hormones (Hormone)
Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.
Menstruation (Menses, Menstrual, Menstrual Cycle, Menstrual Cycles, Menstrual Flow, Menstrual Phase, Monthly Cycle)
The periodic discharge of blood, tissue fluid and mucus from the endometrium (lining of the uterus) that usually lasts from 3 - 5 days. It is caused by a sudden reduction in estrogens and progesterone.
Mucus (Mucous)
The viscous, slippery substance that consists chiefly of mucin, water, cells, and inorganic salts and is secreted as a protective lubricant coating by cells and glands of the mucous membranes.
Ovary (Ovaries)
Ovaries are about the size of an almond and lie on either side of the lower abdomen beside the uterus. They usually produce one egg each month and whether the egg is fertilized or not, the reproductive process follows a monthly cycle, with constant changes in various hormone levels, preparing another opportunity for conception. The ovary is responsible for most of the estrogen production in women. At menopause (sometime after middle-age), egg production ceases and hormone levels drop significantly.
Thyroid (Thyroid Gland)
The thyroid gland is an organ with many veins, anchored around the front of the throat near the voice box. It is essential to normal body growth in infancy and childhood. It absorbs iodine from the diet and releases thyroid hormones - iodine-containing compounds that help govern the rate of the body's metabolism (its total life processes), affecting body temperature, and regulating protein, fat and carbohydrate catabolism in all cells. They keep up growth hormone release, skeletal maturation, and heart rate, force, and output. They promote central nervous system growth, stimulate the making of many enzymes, and are necessary for muscle tone and vigor. To a high degree, metabolism is regulated by the hormone thyroxine, which can be made by the thyroid if enough organic iodine is available. An enlarged thyroid gland that is not cancer is sometimes called goitre.
Uterus (Uterine)
The part of the female reproductive system specialized to allow the implantation, growth and nourishment of a fetus during pregnancy.
Last updated: Jul 04, 2009
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