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Dr. Andrew Rynne
Dr. Andrew Rynne

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Exp 50 years

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Article Home Women's Health Absence of menstruation- Amenorrhea

Absence of menstruation- Amenorrhea

Amenorrhoea is no menstrual cycles for atleast three continous months in a woman of reproductive age. Amenorrhea (primary)is the term used to describe the absence of a period in young women who haven't started menstrual periods by age 16 even after development of other secondary sexual charecteristics like pubic hair, breast etc. Amenorrhea (secondary) is a condition of absent menses occurring after menstrual cycles have become established.

Types of amenorrhea

  • Primary amenorrhea: It is a condition in which there will be no menstrual periods by the age 16. It is the absence of menstrual bleeding and secondary sexual characteristics in a girl by age 14 years or the absence of menstrual bleeding with normal development of secondary sexual characteristics in a girl by age 16 years.
  • Secondary amenorrhea: It is the absence of menstrual bleeding in a woman who had been menstruating but later stops menstruating for 3 or more months.

Causes of primary amenorrhea


  • Chromosomal abnormalities: It can cause premature decrease of eggs and formation of follicle causing absence of ovulation and menstruation.
  • Problems with hypothalamus: Hypothalamus is the part of brain which controls and regulates the menstrual cycle. Excessive exercise, eating disorders,     physical or  psychological stress can contribute to disruption in the normal function of the hypothalamus.
  • Pituitary disease: The pituitary gland in brain is responsible for regulating the menstrual cycle.
  • Lack of reproductive organs: Absence of major reproductive organs like uterus, cervix can lead to amenorrhea.
  • Structural abnormality of vagina like obstruction of the vagina.

Causes of secondary amenorrhea

  • Pregnancy.
  • Contraceptives.
  • Medications like antidepressants, corticosteroids, antipsychotics, chemotherapy drugs.
  • Chronic illness.
  • Breast feeding.
  • Stress.
  • Depression.
  • Hormonal imbalance like PCOS.

When to seek medical advice

  • If the girl is 14 and secondary sexual characteristics (like breast development, pubic hair) have not started to develop or if the girl is 16 and her first periods had not began.
  • For women who had normal menstruation before and have missed 3 consecutive periods.


Tests and diagnosis:

  • Pelvic examination.
  • Pregnancy tests to rule out pregnancy.
  • Blood test to detect hormone levels like thyroid function tests, Prolactin level.
  • Progestin challenge test.
  • Ultrasound scan, CT or MRI scan.


  • Treatment depends on the cause
  • Oral contraceptives can be prescribed.

Lifestyle and home remedies:


  • Changes in diet and exercise activity to have a healthy weight.
  • Healthy balance in work, recreation and rest.
  • Decreasing stress.