absence> 3 menstrual periods

• Article
• 2021-02-27

Amenorrhea (pronounced ey-men-uh-REE-uh or uh-men-uh-REE-uh ) is the medical term for the absence of a period. Amenorrhea is not a disease, but it can be a symptom of another condition.

Primary amenorrhea occurs when a girl has not had her first period by the age of 16. Secondary amenorrhea describes women who experience an absence of more than three menstrual cycles after a regular period.

NICHD supports research into the causes and treatments of primary and secondary amenorrhea, as well as the conditions for which secondary amenorrhea is often a main symptom, such as polycystic ovary syndrome (PCOS) and fragile X-associated primary ovarian insufficiency (FXPOI).

Symptoms

Missing a period is the main sign of amenorrhea.

Depending on the cause, a woman may also have other signs or symptoms, such as:

• Excess facial hair
• Hair loss
• Headache
• Lack of breast development
• Milky discharge from the breasts
• Vision changes

Therapy

Treatment for amenorrhea depends on the underlying cause as well as the individual's health status and goals.

If primary or secondary amenorrhea is caused by lifestyle factors, your healthcare provider may suggest changes in the areas listed below:

• Weight. Being overweight or seriously underweight can affect your menstrual cycle. Achieving and maintaining a healthy weight often helps to balance hormone levels and restore your menstrual cycle.
• Stress . Assess the stress areas in your life and reduce the things that cause stress. If you cannot reduce the stress on your own, seek help from family, friends, your healthcare provider, or a professional listener, such as a counselor.
• Level of physical activity. You may need to change or adjust your physical activity level to restart your menstrual cycle. Talk to your health care provider and your coach or trainer about how to exercise in a way that maintains your health and menstrual cycle.

Be aware of changes in your menstrual cycle and contact your health care provider if you have any concerns. Keep track of when your period occurs. Write down the date your period starts, how long it lasts, and any problems you experience. The first day of bleeding is considered the first day of your menstrual cycle.

For primary amenorrhea , depending on your age and ovarian function test results, health care providers may recommend watchful waiting. If an ovarian function test shows low follicle-stimulating hormone (FSH) or luteinizing hormone (LH) levels, menstruation can simply be delayed. This type of delay is common in women with a family history of delayed periods. ¹

Primary amenorrhea caused by chromosomal or genetic problems may require surgery. Women with a genetic condition called 46, XY gonadal dysgenesis have one X and one Y chromosome, but their ovaries do not develop normally. This condition increases the risk of developing ovarian cancer. The gonads (ovaries) are often removed by laparoscopic surgery to prevent or reduce the risk of cancer. ²

Treatment for secondary amenorrhea can include medical or surgical treatments or a combination of both, depending on the cause.

Medical treatment

Common medical treatments for secondary amenorrhea include: ³

• Birth control pills or other types of hormonal medications . Certain oral contraceptives can help restart the menstrual cycle.
• Medicines to relieve the symptoms of PCOS . Clomiphene citrate (CC) therapy is often prescribed to stimulate ovulation. ⁴
• Estrogen Replacement Therapy (ERT) . ERT can help balance hormonal levels and restart the menstrual cycle in women with primary ovarian insufficiency (POI) or fragile X-associated primary ovarian insufficiency (FXPOI). ⁵ Women with FXPOI often experience menopausal symptoms such as hot flashes and nighttimek sweating. ERT replaces the estrogen that a woman's body should naturally make for a normal menstrual cycle. Additionally, ERT may help women with FXPOI lower their risk of bone disease osteoporosis. ⁶ ERT can increase the risk of uterine cancer, so your health care provider may also prescribe progestin or progesterone to reduce this risk.

Medicines are generally safe, but they can have side effects, some of which can be serious. You should discuss side effects and risks with your health care provider before making a decision on a specific medical treatment.

Surgical treatment

Surgical treatment for amenorrhea is not common, but may be recommended under certain circumstances. Among which:

• Uterine scars . These scars sometimes occur after uterine fibroids removal, a caesarean section, or a dilation and curettage (D&C), a procedure in which tissue is removed from the uterus to diagnose or treat heavy bleeding or to remove the uterine lining after a miscarriage. ⁷ Removing the scar tissue during a procedure called hysteroscopic resection can help restore the menstrual cycle. ⁸

Pituitary tumor. Medicines may be recommended to shrink the tumor. If this doesn't work, surgery may be required to remove the tumor. Pituitary tumors are not cancerous, but they can cause problems during growth. Pituitary tumors can put pressure on surrounding blood vessels and nerves, such as the optic nerve, and lead to vision loss.

Typically pituitary tumors are removed through the nose and sinuses. Radiation therapy can be used to shrink the tumor, either in conjunction with surgery or, for those who cannot have surgery, on their own.

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