Amenorrhea
When menstruation is absent – understanding, diagnosis, and treatment
What is amenorrhea
Amenorrhea is the medical term that describes the absence of menstrual periods. It can be physiological (such as during pregnancy or menopause) or pathological when it occurs outside these periods. It is classified as primary (when a woman has never had a period by age 15–16) and secondary (when a woman with a previously normal cycle stops menstruating for at least 3–6 months). Amenorrhea is a symptom, not a disease.
Identifying the underlying causes and managing them properly can often restore menstrual function and hormonal balance.
Causes of primary and secondary amenorrhea
Amenorrhea can result from various factors affecting the hypothalamus, pituitary gland, ovaries, uterus, or vagina. Stress, eating disorders, intense exercise, or pituitary tumors can interrupt the menstrual cycle. Ovarian insufficiency or premature menopause occurs when the ovaries prematurely cease estrogen production or do not respond to stimulating hormones.
Polycystic Ovary Syndrome (PCOS) can cause rare or absent ovulation, leading to secondary amenorrhea. Anatomical abnormalities, such as absent uterus or cervical stenosis, lead to primary amenorrhea.
Associated symptoms
Weight changes, hair growth, or skin changes
May indicate hormonal imbalances such as PCOS or thyroid disorders.
Hot flashes, vaginal dryness, or sleep disturbances
Often suggest estrogen deficiency, as seen in premature ovarian insufficiency.
Galactorrhea or headaches
May be due to elevated prolactin levels or a pituitary adenoma.
Lack of development or secondary sexual characteristics
In girls with primary amenorrhea, it may be accompanied by delayed physical development.
How diagnosis is made
The diagnostic approach involves a comprehensive evaluation based on medical history, physical examination, and targeted laboratory tests. Hormonal evaluation, including FSH, LH, estradiol, prolactin, TSH, and testosterone, is essential. Pelvic ultrasound assesses the uterus and ovaries for anatomical abnormalities or polycystic appearance. Progesterone and/or estrogen challenge tests assess endometrial response.
In selected cases, MRI of the pituitary gland or karyotype testing is performed to rule out Turner syndrome.
Management based on cause
Amenorrhea is not a disease but a symptom that requires further investigation. With proper medical guidance and individualized treatment, most cases can be effectively managed, restoring menstrual function and hormonal balance. The body sends signals – we just need to listen to them in time.