Amenorrhoea

Overview

Amenorrhoea (ay-men-oh-REE-ah) means the absence of menstrual periods. There are two types: primary amenorrhoea (when someone has never had a period by age 16) and secondary amenorrhoea (when a person who previously had periods stops menstruating for three months or longer). It is not a disease itself but usually a sign of another condition.

Yes – around 3–5% of women of reproductive age experience secondary amenorrhoea at some point.

Primarily affects girls and women of menstrual age. Primary amenorrhoea affects teenagers who have not started their periods on time; secondary amenorrhoea can affect anyone who has had periods, especially during times of stress, weight changes, or hormonal changes.

Symptoms

Common symptoms

• No menstrual period for three or more months (secondary) or never started by age 16 (primary).
• Possible associated symptoms depending on the cause: headaches, vision changes, hot flushes, vaginal dryness, acne, excess facial or body hair, breast tenderness, or milky nipple discharge.

Symptoms in children

• Primary amenorrhoea: no period by age 16, or by age 14 if there are no other signs of puberty (such as breast development).

Symptoms in older adults

• Amenorrhoea in older adults is typically due to menopause, which is a natural part of aging and not a medical problem.

Causes

Main causes

• Pregnancy – the body’s hormones change to support the pregnancy.
• Hormonal imbalances – polycystic ovary syndrome (PCOS), thyroid disorders, high prolactin levels.
• Stress – physical or emotional stress can stop ovulation.
• Low body weight or eating disorders (anorexia nervosa, bulimia).
• Excessive exercise – especially endurance sports or training without enough calories.
• Medications – some antidepressants, blood pressure drugs, or chemotherapy can affect periods.
• Structural problems – scarring of the womb lining (Asherman’s syndrome) or birth defects of the reproductive organs.
• Premature ovarian insufficiency (early menopause before age 40).

Risk factors

• Being underweight or overweight.
• High levels of stress.
• Competitive endurance sports.
• Eating disorders.
• Family history of hormonal conditions (like PCOS or early menopause).
• Certain chronic illnesses (such as diabetes, celiac disease, or adrenal disease).

When to see a doctor

See a doctor urgently if:

• If you have missed three or more periods and are sexually active – seek medical advice to rule out pregnancy and discuss next steps.
• If you have never had a period by age 16.
• If you have sudden vision changes or severe headaches along with missed periods.

Book a routine appointment if:

• If periods have been irregular for several months and you are not pregnant.
• If you notice unusual hair growth, acne, or breast discharge.
• If you are trying to become pregnant and have infrequent or absent periods.

Diagnosis

A healthcare provider will ask about your medical history, menstrual history, weight changes, stress levels, exercise habits, and medications. They will also perform a physical examination and may do blood tests.

Tests that may be done

• Pregnancy test (first step).
• Hormone blood tests (e.g., FSH, LH, prolactin, thyroid hormones, testosterone).
• Pelvic ultrasound to look at the ovaries, uterus, and womb lining.
• Sometimes an MRI of the pituitary gland if prolactin is high.
• A progestogen challenge test (taking a hormone pill to see if bleeding follows).

What to expect at your appointment

The healthcare provider will explain each test and why it is done. Most tests are simple blood tests or a painless ultrasound. You may be referred to a gynaecologist or an endocrinologist (hormone specialist).

Treatment

Treatment depends entirely on the cause. In many cases, simple lifestyle changes can restore periods. If an underlying condition is found (such as PCOS, thyroid disorder, or high prolactin), that condition will be treated first. The goal is to address the root cause and, if pregnancy is desired, to help restore ovulation.

Self-care at home

• Reduce stress through relaxation techniques like yoga, meditation, or talking to a counsellor.
• Maintain a healthy weight – if underweight, gain weight slowly with a balanced diet; if overweight, aim for gradual weight loss.
• Moderate exercise – if you exercise intensely, consider cutting back to a moderate level (e.g., 30–60 minutes most days).
• Ensure you eat enough calories and nutrients – especially calcium and vitamin D for bone health.
• Track your menstrual cycle and note any changes to discuss with your doctor.

Medical treatments

Depending on the cause, doctors may recommend hormone therapy (such as birth control pills or other cyclic hormones) to regulate periods. For PCOS, changes in diet and exercise often help, and medications like metformin may be used to improve insulin resistance (but no drug names will be listed here). If high prolactin is the cause, medications that lower prolactin are available. Thyroid conditions are treated with thyroid hormone replacement. In all cases, the specific medication will be chosen by your doctor and tailored to you.

When is surgery considered?

Surgery is rarely needed. It may be considered if there are structural problems like scar tissue in the womb (Asherman’s syndrome) or a pituitary tumour that does not respond to medications. Your doctor will discuss the risks and benefits if surgery is an option.

Living with this condition

Living with amenorrhoea can be worrying, especially if you wish to become pregnant or if it affects your body image. Most causes are treatable, and periods often return with proper care. It helps to stay in regular contact with your healthcare provider and follow their advice.

Lifestyle tips

• Manage stress – this is one of the most important steps.
• Get enough sleep – aim for 7–9 hours per night.
• Avoid smoking and limit alcohol – both can affect hormone balance.
• Stay active, but not excessively.

Diet and exercise

Eat a well-balanced diet with enough calories for your activity level. Include plenty of fruits, vegetables, whole grains, and protein. If you are underweight, work with a dietitian to gain weight safely. If you are overweight, even a modest weight loss of 5–10% can restore ovulation. Exercise moderately – gentle activities like walking, swimming, or cycling are good. Avoid extreme workouts until your cycles return.

Mental health and emotional wellbeing

Missing periods can affect your self-esteem and cause anxiety, especially if you are concerned about fertility. It is common to feel frustrated or worried. If you feel overwhelmed, please reach out to a mental health professional. If you are having thoughts of harming yourself, call your local crisis support line immediately. You are not alone, and help is available.

Prevention

In some cases, amenorrhoea can be prevented by maintaining a healthy lifestyle: staying at a healthy weight, eating enough, managing stress, and not over-exercising. However, many causes (like PCOS or thyroid disease) cannot be prevented – but they can be managed with early detection and treatment.

Screening programmes

There is no routine screening for amenorrhoea. However, if you miss your periods for several months, see your doctor for a check-up. Regular gynaecological exams can help catch problems early.

Complications

If left untreated

• Infertility – difficulty becoming pregnant if ovulation does not happen regularly.
• Thinning of the bones (osteoporosis) due to low oestrogen levels, which can increase fracture risk.
• Increased risk of heart disease if periods stop early and oestrogen is low for many years.
• Emotional distress and anxiety from unanswered questions about health and fertility.

Long-term outlook

The outlook is generally very good. Most women who receive treatment for their underlying condition will have their periods return. Even if fertility is a concern, many options are available to help conceive. With proper management, amenorrhoea does not have to affect your quality of life or long-term health.

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