Absence of menstruation (amenorrhea): 13 causes

This article explores possible reasons for an absence of menstruation. It also covers when to see a doctor and the treatment options.

What is amenorrhea?

A period, or menstrual bleeding, is the womb lining exiting the body. Amenorrhea is the absence of menstrual bleeding.

During the menstrual cycle, hormones cause an ovary to produce and release an egg. The ovary also releases the hormones estrogen and progesterone.

Estrogen primarily causes the womb lining to thicken, while progesterone prepares the womb for the implantation of an egg.

If no sperm fertilizes the egg, pregnancy does not occur, and the egg dissolves. The levels of estrogen and progesterone decline, and the womb lining falls away. It leaves the body through the vagina, giving the person a period.

If a female reaches the age of 16 without any periods, this is called primary amenorrhea.

Sometimes a person will have no menstrual bleeding for more than three cycles despite having had regular periods until then. If there is no natural cause for this, such as pregnancy, they have secondary amenorrhea. Secondary amenorrhea occurs in approximately 3–5 percent of adult women.

A doctor will recommend the best course of treatment for amenorrhea after diagnosing its underlying cause.

Primary amenorrhea is often due to late puberty, which usually resolves over time. However, a doctor can help determine if there is another underlying cause for periods not beginning. If a hormonal imbalance is responsible, the doctor may prescribe hormonal therapy.

The causes of functional hypothalamic amenorrhea may require lifestyle changes:

  • Low body weight: A doctor may refer an underweight person to a nutritionist who can help them adjust their diet to reach a healthy weight.
  • Stress: Finding ways to manage stress, such as yoga, mindfulness, meditation, or seeing a therapist, may be beneficial.
  • Excessive exercise: The doctor may recommend a moderate exercise regime.

If a person has amenorrhea due to rapid weight gain, the doctor is likely to recommend a calorie-controlled diet and exercise.

In cases where amenorrhea develops due to a structural problem, surgery and an individualized treatment plan may be necessary.


Most causes of absence of menstruation are treatable. Following the treatment plan that a doctor recommends can help many people with amenorrhea regain a regular menstrual cycle.

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