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Absence of menstrual periods


Absence of menstrual periods

Having no menstrual periods is called amenorrhea. It is divided into Primary and secondary.

Primary amenorrhoea is defined as-

  • Absence of start of menses or Menarche by age 16 years in presence of normal Pubertal development.
  • Absence of start of menses or Menarche by age 14 years in absence of normal Pubertal development
  • Absence of start of menses or Menarche 2 years after compilation of sexual maturation.

Secondary Amenorrhoea is defined as-

Absence of menstruation for at least 6 months in females who have already established menstruation. Amenorrhea is normal in the following circumstances:
  • Before puberty
  • During pregnancy
  • While breastfeeding
  • After menopause
  • At other times, it may be the first symptom of a serious disorder.

Amenorrhea may be accompanied by other symptoms, depending on the cause. For example, women may develop masculine characteristics (virilization), such as excess body hair (hirsutism), a deepened voice, and increased muscle size. They may have headaches, vision problems, or a decreased sex drive. They may have difficulty becoming pregnan

Common causes of primary amenorrhea include:

  • A chromosomal or genetic problem with the ovaries (the female sex organs that hold the eggs).
  • Hormonal issues stemming from problems with the hypothalamus or the pituitary gland
  • Structural problems with the reproductive organs, such as missing parts of the reproductive system.

Common causes of secondary amenorrhea include:

  • Pregnancy (which is the most common cause of secondary amenorrhea).
  • Breastfeeding
  • Menopause
  • Chemotherapy and radiation therapy for cancer.
  • Previous uterine surgery with subsequent scarring (for example, if you had a dilation and curettage, often called D&C).

Other causes of secondary amenorrhea can include:

  • Stress
  • Poor nutrition.
  • Weight changes — extreme weight loss or obesity.
  • Exercises associated with low weight.
  • Ongoing illness or chronic illness.
  • You may also have conditions that can cause secondary amenorrhea.
  • Primary ovarian insufficiency, when you experience menopause before age 40.
  • Pituitary disorders, such as a benign pituitary tumor or excessive production of prolactin.
  • Other hormonal problems, such as polycystic ovary syndrome, adrenal disorders or hypothyroidism.
  • Ovarian tumors.
  • Surgery to remove uterus or ovaries.


  • Blood tests to check hormone levels and detect thyroid or Pituitary, adrenal gland disorders.
  • Genetic testing, if you have primary ovarian insufficiency and are younger than 40.
  • Ultrasonography- Abdominal and Pelvic scan.
  • MRI, if your provider suspects a problem with the pituitary gland or hypothalamus.


  • If your period stopped because of menopause or pregnancy, your provider will not need to treat it. In other cases, your treatment will depend on the cause and may include:
  • Losing weight through dieting and exercise (if excess weight is the cause.
  • Gaining weight through an individualized diet plan (if extreme weight loss is the cause).
  • Stress management techniques.
  • Changing exercise levels.
  • Hormonal treatment (medication), as prescribed by your Gynecologist.
  • Surgery (in rare cases) in tumors like Adrenal, pituitary, or Hypothalamic.