Absent menstrual periods - secondary
Amenorrhea - secondary; No periods - secondary; Absent periods - secondary; Absent menses - secondary; Absence of periods - secondaryAbsence of a woman's monthly menstrual period is called amenorrhea. Secondary amenorrhea is when a woman who has been having normal menstrual cycles stops getting her periods for 6 months or longer.
Causes
Secondary amenorrhea can occur due to natural changes in the body. For example, the most common cause of secondary amenorrhea is pregnancy. Breastfeeding and menopause are also common, but natural causes.
Women who take birth control pills or who receive hormone shots such as Depo-Provera may not have any monthly bleeding. When they stop taking these hormones, their periods may not return for more than 6 months.
You are more likely to have absent periods if you:
- Are obese
- Exercise too much and for long periods of time
- Have low body fat (less than 15% to 17%)
- Have severe anxiety or emotional distress
- Lose a lot of weight suddenly (for example, from strict or extreme diets or after gastric bypass surgery)
Gastric bypass surgery
Gastric bypass is surgery that helps you lose weight by changing how your stomach and small intestine handle the food you eat. After the surgery, you...
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Other causes include:
- Drugs for cancer treatment
- Medicines to treat schizophrenia or psychosis
Schizophrenia
Schizophrenia is a mental disorder that makes it hard to tell the difference between what is real and not real. It also makes it hard to think clearl...
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Overactive thyroid gland
Overactive thyroid gland
Hyperthyroidism is a condition in which the thyroid gland makes too much thyroid hormone. The condition is often called overactive thyroid.
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Polycystic ovarian syndrome
Polycystic ovarian syndrome
Polycystic ovary syndrome (PCOS) is a condition in which a woman has increased levels of male hormones (androgens). Many problems occur as a result ...
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- Premature ovarian failure
Also, procedures such as a dilation and curettage (D and C) can cause scar tissue to form. This tissue may cause a woman to stop menstruating. This is called Asherman syndrome. Scarring may also be caused by some severe pelvic infections.
D and C
D and C (dilation and curettage) is a procedure to scrape and collect the tissue (endometrium) from inside the uterus. Dilation (D) is a widening of ...
Read Article Now Book Mark ArticleAsherman syndrome
Asherman syndrome is the formation of scar tissue in the uterine cavity. The problem most often develops after uterine surgery.
Read Article Now Book Mark ArticleSymptoms
In addition to having no menstrual periods, other symptoms can include:
- Breast size changes
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Weight gain or weight loss
Weight gain
Unintentional weight gain is when you gain weight without trying to do so and you are not eating or drinking more.
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Unexplained weight loss is a decrease in body weight, when you did not try to lose the weight on your own. Many people gain and lose weight. Uninten...
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- Acne and increased hair growth in a male pattern
- Vaginal dryness
- Voice changes
If amenorrhea is caused by a pituitary tumor, there may be other symptoms related to the tumor, such as vision loss and headache.
Headache
A headache is pain or discomfort in the head, scalp, or neck. Serious causes of headaches are rare. Most people with headaches can feel much better...
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A physical exam and pelvic exam must be done to check for pregnancy. A pregnancy test will be done.
Pregnancy test
A pregnancy test measures a hormone in the body called human chorionic gonadotropin (HCG or hCG). HCG is a hormone produced during pregnancy. It ap...
Read Article Now Book Mark ArticleBlood tests may be done to check hormone levels, including:
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Estradiol levels
Estradiol levels
An estradiol test measures the amount of a hormone called estradiol in the blood. Estradiol is one of the main types of estrogens.
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Follicle stimulating hormone (FSH level)
Follicle stimulating hormone
The follicle stimulating hormone (FSH) blood test measures the level of FSH in blood. FSH is a hormone released by the pituitary gland, located on t...
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Luteinizing hormone (LH level)
Luteinizing hormone
The LH blood test measures the amount of luteinizing hormone (LH) in blood. LH is a hormone released by the pituitary gland, located on the undersid...
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Prolactin level
Prolactin level
Prolactin is a hormone released by the pituitary gland. The prolactin test measures the amount of prolactin in the blood.
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Testosterone level
Testosterone
A testosterone test measures the amount of the male hormone, testosterone, in the blood. Both men and women produce this hormone. The test described...
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Thyroid stimulating hormone (TSH)
Thyroid stimulating hormone
A TSH test measures the amount of thyroid stimulating hormone (TSH) in your blood. TSH is produced by the pituitary gland. It prompts the thyroid g...
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Other tests that may be performed include:
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CT scan or MRI scan of the head to look for tumors
CT scan
A head computed tomography (CT) scan uses many x-rays to create pictures of the head, including the skull, brain, eye sockets, and sinuses.
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A head MRI (magnetic resonance imaging) is an imaging test that uses powerful magnets and radio waves to create pictures of the brain and surrounding...
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Biopsy of the lining of the uterus
Biopsy of the lining of the uterus
Endometrial biopsy is the removal of a small piece of tissue from the lining of the uterus (endometrium) for examination.
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- Ultrasound of the pelvis or hysterosonogram (pelvic ultrasound that involves putting saline solution inside the uterus)
Hysterosonogram
Transvaginal ultrasound is a test used to look at a woman's uterus, ovaries, tubes, cervix, and pelvic area. Transvaginal means across or through the...
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Treatment
Treatment depends on the cause of amenorrhea. Normal monthly periods most often return after the condition is treated.
A lack of menstrual period due to obesity, vigorous exercise, or weight loss may respond to a change in exercise routine or weight control (gain or loss, as needed).
Obesity
Overweight and obesity mean having a weight than is higher than what is healthy for a given height. A person may be overweight from extra muscle, bo...
Read Article Now Book Mark ArticleOutlook (Prognosis)
The outlook depends on the cause of amenorrhea. Many of the conditions that cause secondary amenorrhea will respond to treatment.
When to Contact a Medical Professional
See your primary health care provider or women's health care provider if you have missed more than one period so you can get diagnosed and treated, if needed.
References
Bulun SE. Physiology and pathology of the female reproductive axis. In Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, et al. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 17.
Cameron S. Menstruation and amenorrhoea. In: Magowan B, ed. Clinical Obstetrics and Gynaecology. 5th ed. Elsevier; 2023:chap 4.
Lobo RA. Primary and secondary amenorrhea and precocious puberty. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 36.
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Secondary amenorrhea - illustration
Secondary amenorrhea is the cessation of menstrual flow for a period of 6 months or more in the absence of pregnancy, breastfeeding or menopause. Extreme weight gain or loss, certain medications, as well as anxiety can be the root cause of amenorrhea. Treatment can range from behavior modification for excessive exercise to medication to surgery in the presence of disease.
Secondary amenorrhea
illustration
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Normal uterine anatomy (cut section) - illustration
The uterus is a muscular organ with thick walls, two upper openings to the fallopian tubes and an inferior opening to the vagina.
Normal uterine anatomy (cut section)
illustration
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Absence of menstruation (amenorrhea) - illustration
Amenorrhea is the lack of menstrual flow and can be a normal occurrence or a sign of malfunction or disease. In primary amenorrhea, menstruation does not begin when expected (by the age of 16). Secondary amenorrhea occurs when the normal established menstrual cycle is shut down for 6 or more months due to a condition other than pregnancy, breastfeeding or menopause.
Absence of menstruation (amenorrhea)
illustration
-
Secondary amenorrhea - illustration
Secondary amenorrhea is the cessation of menstrual flow for a period of 6 months or more in the absence of pregnancy, breastfeeding or menopause. Extreme weight gain or loss, certain medications, as well as anxiety can be the root cause of amenorrhea. Treatment can range from behavior modification for excessive exercise to medication to surgery in the presence of disease.
Secondary amenorrhea
illustration
-
Normal uterine anatomy (cut section) - illustration
The uterus is a muscular organ with thick walls, two upper openings to the fallopian tubes and an inferior opening to the vagina.
Normal uterine anatomy (cut section)
illustration
-
Absence of menstruation (amenorrhea) - illustration
Amenorrhea is the lack of menstrual flow and can be a normal occurrence or a sign of malfunction or disease. In primary amenorrhea, menstruation does not begin when expected (by the age of 16). Secondary amenorrhea occurs when the normal established menstrual cycle is shut down for 6 or more months due to a condition other than pregnancy, breastfeeding or menopause.
Absence of menstruation (amenorrhea)
illustration
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Review Date: 4/16/2024
Reviewed By: John D. Jacobson, MD, Professor Emeritus, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.