Missed Periods
Amenorrhea: Absence of Periods



Missed Periods


Missed Periods - What Is Amenorrhea?
Types of Amenorrhea
What Are The Causes?
How Is It Diagnosed?
How Is It Treated?

Monthly Menstrual Cycle
Overview of periods:
Guide to Menstruation

Missed Periods - What Is Amenorrhea?

Many women of reproductive age will miss a period at some stage in their life. Usually this is nothing to worry about. Menstrual cycle changes can be caused by normal life situations such as stress, a change in contraceptive pill, breastfeeding or an unhealthy diet. Of course one of the most common reasons for a missed period is pregnancy. However, if you are not pregnant and periods do not return within 6 months, you may have amenorrhea. Amenorrhea is the absence of menstrual periods in pre-menopausal women.

Types of Amenorrhea

There are three types of amenorrhea. Primary amenorrhea is where a girl fails to start menarche (her first period) by the age of 16 but her breasts have already started to develop. This condition affects about 1 in every 1,000 teenagers (see, when should my periods start?). Secondary amenorrhea is defined as an absence of periods for 6 months or longer in women who previously had regular periods but who are not pregnant or breastfeeding. Physiologic amenorrhea is the absence of periods during pregnancy and breastfeeding which is perfectly normal.

Although it may be tempting to say that life is more convenient without periods, primary and secondary amenorrhea should be investigated. The female body is naturally designed to have monthly bleeds, and the absence of periods suggests some sort of hormone imbalance or underlying gynecological disorder which may need treating. Additionally, not having a menstruation increases the risk of osteoporosis in women. Amenorrhea can also affect a woman's fertility, although this does not mean a woman with amenorrhea cannot become pregnant - some form of birth control method still needs to be used if pregnancy is not desired.

What Are The Causes?

Pregnancy: A missed period is one of the first early signs of pregnancy. Maybe obvious, but this can quickly be ruled in or out with a pregnancy test. If you are not pregnant, the following are other potential causes:

Breastfeeding: Mothers who breastfeed often experience missed periods, but as ovulation can still occur without a menstrual bleed, pregnancy precautions should still be taken.
Are you experiencing an unusual amount of stress? Stress can not only cause missed periods, but also heavy and painful periods. Take our online stress test to check your levels.
Unhealthy Diet:
Are you eating more junk than normal? This is more likely to be a factor in causing painful or heavy periods, rather than missed periods. However, excessive dieting and extreme calorie reduction can cause missed periods. Women with eating disorders such as anorexia or bulimia often experience amenorrhea.
Excessive Exercise: Competitive female athletes have a high risk of developing amenorrhea. In fact 50 percent of long distance runners (those who run 80 miles or more a week) develop amenorrhea and 44 percent of professional ballet dancers. This is probably an evolutionary response of the body. Reducing a woman's fertility when food was scarce prevented birth of offspring who were unlikely to survive in the harsh conditions.
Severe Illness:
If you have experienced a chronic illness for any period of time, your menstrual cycle may temporarily change, you may even develop irregular periods. Once you have recovered, your cycle should too.
Thyroid Disease:
A common side effect of an untreated thyroid disease is periods stopping.
Elevated Prolactin Hormones:
1 in 5 women with amenorrhea have elevated prolactin levels. These are the hormones that stimulate the breasts to increase milk and simultaneously stop ovulation.
Hyperandrogenism: A condition where there are raised androgens levels (the hormones which cause masculine traits). If untreated, this can lead to endometrial hyperplasia and even cancer.
PCOS: Polycystic ovary syndrome, which can also lead to raised androgens levels.
Ovarian Cysts: Certain types of cysts can be associated with menstrual irregularities, see can ovarian cysts cause a missed period?
Primary Amenorrhea:
In rare instances an imperforate hymen may stop blood flow. In even rarer cases genetic disorders such as Turner syndrome, or gland disorders or tumors can cause lack of menstruation.

If you have missed 3 periods in a row, you should consult your doctor for a professional diagnosis (particularly if you also experience hair loss, blurred vision and breast secretions).

How Is It Diagnosed?

Primary amenorrhea does not usually require diagnosis or treatment until the age of 18 if there are other signs of normal puberty such as underarm hair and breast enlargement. If you are concerned however, a doctor can carry out a quick pelvic exam to determine if there are any blockages or any other causes. After the age of 18, if periods still do not occur, more extensive testing will be carried out. Before diagnosing secondary amenorrhea, pregnancy and menopause (see menopause testing) will need to be ruled out. If this happens, a complete history of your menstrual cycle will be taken. A pelvic exam should happen and certain hormone tests. Alternatively a blood test may be carried out to check if ovulation is occurring. In certain cases, tests for thyroid, PCOS and other suspected conditions may be completed.

How Is It Treated?

If an underlying condition has been diagnosed, treatment for amenorrhea will involve treatment for the condition. Once this has been resolved, your periods should return. However, where there is no apparent reason for missing periods, the following options are available:

The 'Pill': Doctors often prescribe the contraceptive pill with estrogen to teenagers who have not started their periods (menarche) by the age of 15. It may also be recommended to women in their 20s and 30s who wish to have their menstrual cycle regularized.

Healthy Diet: A healthy Low GI plan may be recommended to help the body develop a natural rhythm. Women who are above the healthy BMI range for their height usually find premenstrual symptoms (PMS) also reduce with weight, as well as symptoms to do with heavy periods or premenstrual dysphoric disorder.

Vitamins and Minerals: Calcium, magnesium, zinc and B-vitamins are recommended for any women with menstrual problems. A B-vitamin complex (100 mg per vitamin) can help ovary/egg production. Zinc (15mg per day) is important for hormone production and it may be lacking if you have been on the pill for a few years. Magnesium (300 mg per day) is nature's 'tranquillizer' and is good for keeping the body balanced during stressful times. See also PMS treatment for more ideas.

Related Questions
What is the difference between the emergency contraception pill and the normal pill?
What are the early signs of pregnancy before a missed period?

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For more about menstrual cycles, see the following:

Fibroids Symptoms
Functional Ovarian Cysts
Endometriosis Diagnosis

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