Amenorrhea is the medical term for the absence of menstrual periods, which are periods of normal vaginal bleeding that occur in females assigned at birth as part of their monthly cycle. In a typical monthly cycle, a person’s period occurs once every 24-38 days.

Amenorrhea can be normal in certain circumstances, such as during pregnancy or after menopause. However, underlying conditions, certain medications, and genetics can cause you to miss your period even if you’re not pregnant or menopausal.

There are two types of amenorrhea: primary and secondary. Primary amenorrhea is when you don’t have a menstrual period by the age of 15 or three years after the start of breast growth. Secondary amenorrhea occurs when you previously had regular menstrual cycles but have not had a menstrual period for three or more months.

The main symptom of amenorrhea is missing your period or not having your period by a certain age. Other symptoms may accompany amenorrhea, including:

• Headaches
• Vision changes
• Milky fluid leaking from breasts
• Hair loss
• Excess facial hair
• Nausea
• Lack of breast development

Amenorrhea can occur due to several reasons, ranging from family history to certain health conditions.

A family history of amenorrhea, genetics, and certain lifestyle factors can cause primary amenorrhea. Meanwhile, underlying health conditions, birth control, certain medications, and cancer treatment can lead to secondary amenorrhea.

Family History

If someone in your family had primary amenorrhea or experienced early menopause, you are at a higher risk of having primary amenorrhea as well.

Genetics

Your chromosomes (structures that carry genetic information) or genetic abnormalities can affect ovary function and the menstrual cycle.

Ovaries play an important role in the monthly cycle because they release an egg for sperm fertilization in the ovulation (egg release) phase of your cycle, in addition to producing the hormones estrogen and progesterone.

One example of ovarian dysfunction is Turner syndrome. This chromosomal health condition causes amenorrhea and is characterized by signs and symptoms such as a low hairline, webbed neck, and widely spaced nipples.

Lifestyle Factors

Lifestyle factors that may cause primary amenorrhea include eating disorders, eating a low-nutrient diet, overexercising, and high levels of stress.

These lifestyle factors can contribute to hypothalamic-pituitary-ovarian (HPO) axis impairment, which can cause functional hypothalamic amenorrhea (FHA). The HPO axis controls the reproductive cycle. When it is not properly supported by sufficient nutrients or is affected by extreme stress and exercise, FHA can result.

Certain Health Conditions

A variety of health conditions can lead to secondary amenorrhea—meaning that you once had menstrual periods but are no longer experiencing them. These causes include:

• Pregnancy: Hormonal changes during pregnancy are normal and lead to the absence of the monthly menstrual cycle.
• Breastfeeding: Breastfeeding is a natural cause of amenorrhea because it inhibits the progression of the follicular phase (the first half) of the menstrual cycle.
• Menopause: This is the natural phase of menstruation that causes your ovarian, estrogen, and progesterone production to decrease significantly, gradually making menstrual cycles less regular and eventually leading to the end of the menstrual cycle.
• Polycystic ovary syndrome (PCOS): PCOS is an imbalance of reproductive hormones, which causes problems in the ovaries that result in irregular or missed periods.
• Thyroid or pituitary gland conditions: Hyperthyroidism (overactive thyroid) and hypothyroidism (underactive thyroid) can affect the HPO axis and result in menstrual irregularities. Hormone-secreting pituitary tumors in the pituitary gland (a pea-sized gland at the base of the brain) can also disrupt the HPO axis and cause you to miss your period.

Birth Control

Some types of birth control, such as oral contraceptives, intrauterine devices (IUDs), and injections, can affect a person’s menstrual cycle during and after use.

Birth control pills containing the hormone progestin can suppress the growth of the endometrium (the layer of tissue lining the uterus) and may lead to secondary amenorrhea.

Medications

Certain types of medications can lead to secondary amenorrhea. While birth control pills can affect your cycle, antidepressants and blood pressure medications can also disrupt the regular function of the menstrual cycle and ovulation, leading to missed periods.

Cancer Treatments

Chemotherapy and radiation treatments for breast, gynecologic, and blood cancers can damage estrogen-producing cells and eggs in the ovaries, which leads to secondary amenorrhea.

This type of secondary amenorrhea may be acute (short-term), especially in younger people. As you complete treatment, your periods may come back.

It’s a good idea to seek medical attention for amenorrhea if you do not get your first menstrual period by age 15 or three years after the start of breast growth. You should also see a healthcare provider if you previously had regular periods but have not had one for at least three months.

If you are a parent or guardian and see no signs of puberty (such as breast growth) in your child by age 13 or if they are experiencing symptoms of amenorrhea, such as changes in vision, milky breast fluid, or hirsutism (the growth of excess facial hair), it’s a good idea to talk to their healthcare provider. These symptoms could be signs of amenorrhea and require a proper diagnosis.

A healthcare provider can diagnose amenorrhea by asking you questions about your menstrual cycle and history, as well as your lifestyle habits.

Your provider may ask you to undergo diagnostic tests such as a pregnancy test, blood tests to measure hormone levels, or imaging tests to examine the reproductive system. They may prescribe hormonal medications to see if those can trigger a period. To check for genetic disorders, they may also take blood and tissue samples to examine chromosomes.

Amenorrhea can affect every person differently, and treatment options often vary.

To treat primary amenorrhea, your healthcare provider will need to identify and treat the underlying cause, such as a genetic condition. Healthcare providers may recommend surgery if a genetic or chromosomal condition is causing your symptoms.

They may also recommend certain lifestyle changes, such as:

• Making dietary changes
• Adjusting exercise levels
• Managing stress
• Taking birth control pills, which can sometimes trigger a period

To treat secondary amenorrhea, your healthcare provider may use medical treatment or surgery. Your exact treatment plan will depend on what’s causing your symptoms.

If PCOS is the cause of your amenorrhea, your provider may recommend fertility medications such as clomiphene citrate (CC) therapy to help you ovulate. A thyroid condition causing amenorrhea may require hormone therapy, thyroid surgery, or other medications.

It’s not always possible to prevent amenorrhea, especially if your symptoms are due to a genetic condition. However, there are some evidence-backed tips that you can implement to take care of your overall reproductive health. These strategies include the following:

• Visit your healthcare provider if you are experiencing symptoms of amenorrhea and getting treatment early
• Eat a nutritious and balanced diet
• Move your body regularly
• Participate in stress-reduction activities, such as meditation and yoga
• Keep track of your menstrual periods each month to understand your patterns and recognize when an issue may be occurring

Complications of amenorrhea are possible, but they are often due to the underlying health conditions that cause secondary amenorrhea. Complications may include:

• Hot flashes and night sweats due to menopause
• Infertility due to PCOS
• Increased risk of heart disease and stroke due to thyroid disease

People with amenorrhea may also be at a higher risk of anxiety, depression, galactorrhea (breast milk production that’s unrelated to childbirth), excess hair growth, and acne. This may be related to a problem with your hormones, or it can be a side effect of your amenorrhea.

Amenorrhea is the medical term for the lack of a menstrual period. Genetics, lifestyle factors, medications, and certain health conditions (like PCOS or thyroid disease) can cause you to miss your periods—or never have one in the first place.

Amenorrhea can be normal if you are pregnant, breastfeeding, or undergoing menopause. However, if you never had a period or used to have a period and haven’t had one for at least three months, talk to your healthcare provider about your symptoms.