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A delayed period often causes concern, especially if pregnancy has been ruled out. In some cases, this may be a temporary reaction of the body to stress, sudden weight loss, or excessive physical activity, but a prolonged absence of periods is often associated with hormonal disorders or diseases of the reproductive system and requires examination.

In this article, we will explain what amenorrhea is, what causes the absence of periods, when this condition is physiological, and when it requires treatment. We will also explain which examinations help determine the cause of the absence of menstruation and which treatment methods are used depending on the diagnosis.

What is amenorrhea

Amenorrhea is the absence of menstruation in a woman of reproductive age for a certain period of time, if it is not related to pregnancy, breastfeeding, or menopause. It is not a separate disease, but a symptom that may occur as a result of physiological changes, hormonal disorders, gynecological, endocrine, and other diseases.

When evaluating this condition, the doctor always takes into account the woman's age, menstrual cycle characteristics, and accompanying symptoms. For example, in adolescents, the cycle may still be establishing during the first years after menarche, whereas in a woman who previously had regular periods, their sudden cessation is a reason for examination.

Doctors at «Oxford Medical» recommend: do not ignore a prolonged absence of periods, even if it is not accompanied by pain or other complaints. The earlier the cause of this condition is identified, the sooner the necessary treatment can be started and possible complications can be prevented.

Types of amenorrhea

Amenorrhea can occur at different ages and under different circumstances. That is why doctors distinguish several types of this condition, each of which has its own characteristics and possible causes.

A menstrual cycle disorder in the form of amenorrhea can have different origins — it can be physiological or pathological, primary or secondary. Understanding which type of amenorrhea is present helps assess the situation correctly and determine the further approach to examination and treatment.

Primary amenorrhea

Primary amenorrhea is considered when menstruation has not started by the age of 15 in the presence of normal development of secondary sexual characteristics, or within three years after the beginning of breast development. Most often, this condition is associated with congenital features of the development of the reproductive organs, genetic syndromes, or hormonal disorders.

Doctors at «Oxford Medical» note: if menstruation has not started by the age of 15, or if signs of puberty have not appeared by this age, a consultation with a gynecologist should not be postponed. Timely examination helps detect possible developmental abnormalities or hormonal disorders at an early stage.

Secondary amenorrhea

Secondary amenorrhea is the cessation of menstruation in a woman who previously had a regular or irregular cycle. Usually, it is considered if menstruation is absent for three months with a regular cycle or for six months with an irregular cycle.

  • The cause may be hormonal disorders;
  • sudden weight loss;
  • intense physical activity;
  • pregnancy;
  • ovarian diseases;
  • endocrine disorders;
  • other conditions.

The secondary form is significantly more common than the primary one.

Physiological amenorrhea

Physiological amenorrhea is not associated with a disease and occurs during periods when the absence of menstruation is natural for the body. Such conditions include:

  • pregnancy;
  • breastfeeding;
  • menopause.

In these cases, treatment is not required, because menstrual function changes according to natural processes in the body.

Lactational amenorrhea

Lactational amenorrhea occurs during breastfeeding because of an increased level of prolactin, which suppresses ovulation. That is why after childbirth, periods may be absent for several months.

At the same time, breastfeeding does not guarantee complete protection against pregnancy. With the restoration of ovulation, conception may occur even before the first menstruation appears.

Pathological amenorrhea

Pathological amenorrhea occurs as a result of disorders of the reproductive, endocrine, or nervous system. The most common causes include:

  • hormonal disorders;
  • ovarian diseases;
  • uterine pathology;
  • disorders of the pituitary gland or hypothalamus;
  • some chronic diseases.

That is why treatment is always aimed primarily at eliminating the cause.

False amenorrhea

False amenorrhea is a condition in which the menstrual cycle and hormonal changes are preserved, but menstrual blood cannot exit due to a mechanical obstruction. The cause may be congenital anomalies in the development of the reproductive organs or, less often, scar changes after surgery or injuries. In this case, a woman may feel cyclic pain in the lower abdomen, although there is no bleeding.

Doctors at «Oxford Medical» note: it is important to distinguish false amenorrhea from true amenorrhea, because the treatment approach for these conditions differs fundamentally.

Psychogenic amenorrhea

Psychogenic amenorrhea may develop after severe or prolonged stress, psycho-emotional exhaustion, or severe psychological experiences. Such conditions affect the work of the brain centers that regulate the menstrual cycle. After eliminating the stress factor, the cycle sometimes restores on its own, but in many cases a woman needs comprehensive examination and treatment.

Hypothalamic amenorrhea

Hypothalamic amenorrhea develops due to dysfunction of the hypothalamus — the part of the brain that regulates the production of hormones controlling the menstrual cycle. Most often, it occurs after sudden weight loss, prolonged calorie deficiency, intense sports training, or chronic stress.

In many women, after the cause is eliminated, the menstrual cycle gradually restores. However, sometimes this requires correction of nutrition, lifestyle, and medication therapy.

Causes of amenorrhea

Causes of amenorrhea

The causes of the absence of periods can be different — from natural physiological conditions to hormonal disorders and gynecological diseases. As noted by the American College of Obstetricians and Gynecologists (ACOG), the absence of menstruation may be associated with many conditions, including:

  • pregnancy;
  • breastfeeding;
  • hormonal disorders associated with diseases of the hypothalamus, pituitary gland, ovaries, or thyroid gland;
  • polycystic ovary syndrome;
  • premature ovarian insufficiency;
  • sudden weight loss, low body weight, or eating disorders;
  • obesity, which may affect hormonal balance;
  • excessive physical activity;
  • severe or prolonged stress;
  • congenital anomalies in the development of the reproductive organs;
  • taking certain medications.

Doctors at «Oxford Medical» recommend: do not try to find out on your own why there are no periods. The same symptom may have different causes, so only after examination is it possible to establish the correct diagnosis, determine the cause of amenorrhea, and choose effective treatment.

Amenorrhea in adolescents

In the first years after the first menstruation appears, the cycle in girls is often irregular. This is because the hormonal system is still developing, so the intervals between periods may vary. As noted by MSD Manual, in most adolescents, the menstrual cycle gradually becomes regular within several years after menarche.

At the same time, a prolonged absence of periods in adolescents is not always a normal variant. If menstruation does not appear at the age when it is already expected, or stops after the cycle has already become established, it is necessary to see a doctor to rule out congenital developmental features, hormonal disorders, and other possible causes.

What to do if there are no periods at 13

In most girls at the age of 13, the absence of menstruation is not yet a cause for concern, especially if puberty is progressing according to age: the breasts are developing, pubic and underarm hair appears, and active growth is noted.

However, it is necessary to see a doctor earlier if:

  • signs of puberty have not appeared by the age of 13;
  • periodic lower abdominal pain occurs without the appearance of menstruation;
  • there is significant delay or acceleration of physical development;
  • there are chronic diseases or symptoms that may indicate hormonal disorders.

Doctors at «Oxford Medical» recommend: do not compare a child's development with peers. The timing of puberty may vary, so it should be assessed by a doctor taking into account age, physical development, and general health.

What to do if there are no periods at 14

If there are no periods at the age of 14, this may also be an individual feature of development. However, at this age it is already important to assess the course of puberty. If, in addition to the absence of menstruation, excessive hair growth, acne, or other signs of hormonal imbalance appear, an examination is necessary.

During the consultation, the doctor evaluates the girl’s physical development, collects medical history, and, if necessary, prescribes:

  • pelvic ultrasound;
  • blood tests to determine the levels of FSH, LH, estradiol, prolactin, thyroid-stimulating hormone, and other hormones;
  • a blood test for genetic testing, namely karyotyping.

Timely examination makes it possible to determine whether the absence of menstruation is related to individual developmental features or whether it is a manifestation of a disease that requires treatment.

Diagnosis of amenorrhea

Diagnosis of amenorrhea

If the absence of periods is not related to pregnancy, breastfeeding, or menopause, first of all a consultation with a gynecologist is needed. After the examination and assessment of symptoms, the doctor determines which tests and examinations will help establish the cause of amenorrhea. As noted by the American Society for Reproductive Medicine (ASRM), the scope of diagnosis depends on the patient’s age, clinical manifestations, and the probable cause of this condition.

If necessary, the doctor may recommend:

  • a pregnancy test — to rule out pregnancy as the most common cause of the absence of menstruation;
  • pelvic ultrasound — to assess the condition of the uterus, endometrium, and ovaries;
  • blood tests to determine the levels of FSH, LH, estradiol, prolactin, thyroid-stimulating hormone, and other hormones — to detect possible hormonal disorders;
  • MRI of the brain — if there is suspicion of a disease of the pituitary gland or hypothalamus;
  • hysteroscopy — if it is necessary to examine the uterine cavity in detail and rule out its pathology;
  • genetic testing, namely karyotyping — if congenital chromosomal disorders that may be the cause of primary amenorrhea are suspected.

Doctors at «Oxford Medical» recommend: do not wait for the cycle to restore on its own. The earlier the cause of amenorrhea is identified, the sooner treatment can be started and possible complications can be prevented.

Treatment of amenorrhea

After establishing the cause of amenorrhea, the doctor creates an individual treatment plan. Its goal is not only to restore the menstrual cycle, but also to eliminate the disorder that led to the cessation of menstruation, as well as to prevent possible complications.

Depending on the cause of amenorrhea, treatment may include:

  • lifestyle correction — normalization of body weight, balanced nutrition, reduction of excessive physical activity and stress levels;
  • hormonal therapy — in case of deficiency or excess of certain hormones;
  • treatment of diseases of the thyroid gland, pituitary gland, and other endocrine disorders;
  • treatment of gynecological diseases, including polycystic ovary syndrome;
  • psychotherapy or consultation with a psychologist — if amenorrhea is associated with prolonged stress or eating disorders;
  • surgical treatment — in case of congenital anomalies in the development of the reproductive organs, intrauterine adhesions, or other conditions requiring surgical intervention.

Doctors at «Oxford Medical» recommend: do not try to find out on your own why there are no periods, and do not self-medicate. Incorrect treatment may temporarily change the menstrual cycle pattern, but it will not eliminate the cause of the disorder.

If there are no periods, you should not wait for the cycle to restore on its own. Timely consultation with a gynecologist helps identify the cause of amenorrhea, start the necessary treatment, and preserve reproductive health.

What amenorrhea can lead to if it is not treated

The consequences of amenorrhea depend on the cause that triggered it and the duration of the disorder. In some cases, a temporary absence of menstruation does not pose a threat to health. However, if amenorrhea is associated with a serious disease, it may lead to complications.

Possible consequences include:

  • progression of the disease that caused amenorrhea, if it is not treated in time;
  • increased risk of endometrial hyperplasia in certain hormonal disorders, when the endometrium is exposed to estrogens for a long time without regular shedding;
  • infertility or difficulty becoming pregnant due to the absence of ovulation;
  • decreased bone mineral density and an increased risk of osteopenia and osteoporosis due to prolonged estrogen deficiency;
  • deterioration in quality of life due to anxiety, uncertainty about reproductive health, and the appearance of other symptoms of the underlying disease.

Doctors at «Oxford Medical» note: the danger lies not in amenorrhea itself, but in the cause that led to the cessation of menstruation. That is why it is important not to postpone examination even when there are no other complaints.

The earlier the cause of amenorrhea is established and treatment is started, the higher the chances of restoring the menstrual cycle, preserving reproductive health, and preventing complications.

Prevention of amenorrhea

Prevention of amenorrhea

Not all cases of amenorrhea can be prevented, because some of them are associated with congenital developmental features or diseases of the endocrine system. At the same time, a healthy lifestyle and regular preventive examinations help reduce the risk of developing many causes of menstrual cycle disorders and detect a problem in time.

To maintain normal menstrual function, doctors recommend:

  • maintaining a normal body weight and avoiding sudden weight loss;
  • eating a complete and balanced diet;
  • avoiding excessive physical activity without sufficient recovery;
  • controlling stress levels where possible and taking care of adequate sleep;
  • treating gynecological and endocrine diseases in time;
  • having a preventive examination by a gynecologist at least once a year, even if there are no complaints.

Doctors at «Oxford Medical» recommend: do not ignore any changes in the menstrual cycle. The earlier the cause of the disorder is identified, the easier it is to restore reproductive health and prevent complications.

If menstruation does not appear at the usual time or the cycle changes significantly, do not postpone a visit to a gynecologist. Timely diagnosis and properly selected treatment help eliminate the cause of amenorrhea and preserve women’s health.

The information is for informational purposes only and does not replace a doctor's consultation.

Sources:

US National Library of Medicine

Cochrane Library

National Institute for Health and Care Excellence