Last Updated: May 26, 2019

Definition - What does Amenorrhea mean?

Amenorrhea is the lack of menstrual periods. Not having a period can have many causes, ranging from hormone disorders to congenital (from birth) abnormalities. A woman without periods is usually unable to get pregnant until the cause of her amenorrhea is treated because a lack of menstruation usually also means a lack of ovulation.

FertilitySmarts explains Amenorrhea

Lack of menstruation can be divided into two types, which generally have different causes.

In primary amenorrhea, a girl or woman never began menstruating. Lack of menstruation by the age of 16, in the absence of pregnancy, is considered diagnostic of primary amenorrhea. Causes of primary amenorrhea include:

  • Problems with the pituitary gland. This gland, located in the brain, is responsible for releasing luteinizing hormone and follicle-stimulating hormone. These hormones are responsible for prompting menstruation and the release of other hormones by the ovaries. Pituitary gland failures can often be corrected by the administration of artificial hormones to prompt the ovaries to carry out ovulation and menstruation.
  • Genetic syndromes affecting the reproductive organs. A variety of genetic syndromes such as androgen insensitivity, Turner Syndrome, and congenital adrenal hyperplasia, may prevent menstruation from developing normally during puberty. Whether these conditions can be treated to induce normal menstruation and fertility depends on the syndrome. Medical exam and genetic analysis can be used to determine if syndromes causing primary amenorrhea are present.
  • Congenital malformations. In rare cases, the ovaries or uterus may fail to form properly without the presence of a genetic syndrome. In some cases, these abnormalities can be treated using surgery. In other cases, such as cases where the ovaries do not develop properly, menstruation and fertility may not be possible.

In secondary amenorrhea, a woman who used to have periods stops experiencing them. This can be caused by many factors, most of which are treatable or reversible. Causes of secondary amenorrhea include:

  • Hormonal problems, such as thyroid problems, polycystic ovary syndrome (PCOS), or pituitary tumors. These are usually treatable with medication, and women may experience marked improvement in their quality of life as well as fertility with treatment.
  • High physical or emotional stress. Stress caused by factors including anxiety or depression, severe weight loss, and extreme exercise regimens can cause the body to stop menstruation and ovulation. Evolutionary biologists believe that this may be an evolved response to famine, which prevents pregnancy when there is not enough food available to support the existing population. Fertility can usually be restored by lowering stress levels, restoring good nutrition, and in some cases hormonal medication. Women with secondary amenorrhea due to stress may also experience marked improvements in quality of life, in addition to fertility restoration, with treatment.
  • Complications caused by surgery. In some cases, following dilation and curettage or other uterine surgery, the uterus may form scar tissue or adhesions which can prevent normal buildup or shedding of the uterine lining. This is called Asherman's syndrome. Some women with Asherman's syndrome can have fertility restored through treatment that removes the adhesions. It is important that Asherman's syndrome causing amenorrhea be treated regardless of fertility outcome because it can also cause an increased risk of cancer.
  • Temporary amenorrhea following contraceptive use. Sometimes, menstruation may cease for up to a few months after the use of hormonal contraceptives. In these cases, menstruation should begin again on its own in three months or less.

Diagnosis by a doctor is the best way to determine the cause of amenorrhea. Proper diagnosis and treatment can be important for patients, both in order to restore fertility and for the patient's own long-term health and quality of life.

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