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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
Nutritional deficiency
Pituitary causes
Other pituitary tumors (for example, Cushing syndrome, acromegaly, or thyroidstimulating hormone)
Postpartum pituitary necrosis (death of pituitary cells after a woman delivers a baby)
Autoimmune hypophysitis (cells of the pituitary gland destroyed by the bodys own
defense system)
Pituitary radiation
Sarcoidosis
Ovarian causes
Autoimmune oophoritis (cells of the ovaries destroyed by the bodys own defense
system)
Fragile X premutation
Radiation or chemotherapy
Intrauterine adhesions (the opposing surfaces of the uterine cavity stick together)
Aplasia (absence of an organ or tissue) of the vagina, the cervix, or the uterus
Functional causes
Anorexia/bulimia
Malnutrition
Psychotropic drug use (drugs prescribed to stabilize or improve mood, mental status,
or behavior)
Excessive stress
Excessive exercise
Secondary amenorrhea occurs when a woman who has been having normal menstrual cycles
stops getting her periods for 6 or more months.
Amenorrhea is when a woman does not get her monthly menstrual cycle, or period.
See also:
Menstruation - Absent
Primary amenorrhea
Causes
Women who are pregnant, breastfeeding, or in menopause are not considered to have
secondary amenorrhea.
Women who are taking birth control pills or receive hormone shots such as Depo-Provera
may not have any monthly bleeding. When they stop taking these hormones, their periods
may not return for more than 6 months.
You are more likely to have amenorrhea if you:
Are obese
Lose a lot of weight suddenly (for example, with a strict diet or after
gastric bypass surgery)
Thyroid dysfunction
Busulfan
Chlorambucil
Cyclophosphamide
Phenothiazines
Also, procedures such as a dilation and curettage (D and C) can lead to scar tissue formation
that may cause a woman to stop menstruating. This is called Asherman syndrome. Scarring
may also be caused by some severe pelvic infections.
Symptoms
Previously had one or more menstrual periods that started on their own
Headache
Vaginal dryness
Voice changes
If amenorrhea is caused by a pituitary tumor, there may be other symptoms related to the
tumor, such as vision loss.
Estradiol levels
Prolactin level
Endometrial biopsy
Genetic testing
Treatment
Treatment depends on the cause of the amenorrhea. Normal monthly periods usually return
after the condition is treated.
For example, if the primary disorder is hypothyroidism, amenorrhea will be cured when it is
treated with thyroid supplements.
If the primary cause is obesity, vigorous exercise, or weight loss, treatment may include a
change in exercise routine or weight control.
Outlook (Prognosis)
The outlook depends on the cause of amenorrhea. Most of the conditions that cause
secondary amenorrhea will respond to treatment.
Possible Complications
Complications depend on the cause of the condition. Amenorrhea may be harmless, or it may
be associated with overgrowth of the uterine lining (endometrial hyperplasia). This can
sometimes lead to uterine cancer.
There may be other complications, depending on the cause of the amenorrhea.
Prevention
Prevention depends on the cause. For example, moderate exercise instead of extreme
exercise, weight control, and other measures may be helpful.
Amenorrhea - primary
Amenorrhea is the absence of menstruation. Menstruation is a woman's monthly period.
Primary amenorrhea is when a girl has not yet started her monthly periods, and she:
Has gone through other normal changes that occur during puberty
Is older than 15
See also:
Menstruation - absent
Secondary amenorrhea
Causes
Most girls begin menstruating between ages 9 and 18, with an average around 12 years old.
Primary amenorrhea typically occurs when a girl is older than 15, if she has undergone other
normal changes that occur during puberty. Primary amenorrhea may occur with or without
other signs of puberty.
Being born with poorly formed genital or pelvic organs (missing uterus or vagina, vaginal
septum, cervical stenosis, or imperforate hymen) can lead to primary amenorrhea.
Hormones play a big role in a woman's menstrual cycle. Hormone problems can occur when:
Changes occur to the parts of the brain where hormones that help manage
the menstrual cycle are produced
Genetic defects
Tumors
Adrenogenital syndrome
Anorexia
Craniopharyngioma
Cushing's disease
Cystic fibrosis
Gonadal dysgenesis
Hypogonadotropic hypogonadism
Hyperprolactinemia
Obesity
Prader-Willi syndrome
Testicular feminization
True hermaphroditism
Symptoms
A female with amenorrhea will have no menstrual flow with or without other signs of
puberty.
Estradiol
FSH
LH
Prolactin
TSH
T3 and T4
17 hydroxyprogesterone
Chromosome analysis
Head CT
Laparoscopy
Pelvic ultrasound
Progesterone withdrawal
Serum progresterone
Treatment
Treatment depends on the cause of the missing period. Primary amenorrhea caused by birth
defects may require medications (hormones), surgery, or both.
If the amenorrhea is caused by a tumor in the brain (pituitary tumor):
If the condition is caused by a body-wide (systemic) disease, treatment of the disease may
allow menstruation to begin.
If the amenorrhea is due to low weight because of anorexia or too much exercise, periods will
often begin when the weight returns to normal or the exercise level is decreased.
Outlook (Prognosis)
Overall the outlook is good, depending on the cause of the amenorrhea. If the amenorrhea is
caused by one of the following conditions, there is a good chance that it can be corrected with
medication, lifestyle changes, or surgery:
Adrenogenital syndrome
Chronic illness
Hypogonadotropic hypogonadism
Malnutrition
Obesity
Overactive thyroid
Periods are unlikely to start on their own if the amenorrhea was caused by one of the
following conditions:
Craniopharyngioma
Cystic fibrosis
Gonadal dysgenesis
Prader-Willi syndrome
True hermaphroditism
Possible Complications