Amenorrhoea
Amenorrhoea means the absence of menstrual periods. It may occur when periods do not start during adolescence or stop after previously occurring. Pregnancy, breastfeeding and menopause can explain absent periods, but other causes include hormonal changes or underlying health conditions. Assessment can help identify whether treatment is needed.
Commonality
Secondary amenorrhoea, where periods stop after previously being regular, is more common than primary amenorrhoea, where periods never start during adolescence.
Causes
There are many possible causes of amenorrhoea, including hormonal, structural and lifestyle-related factors.
Common causes include:
Pregnancy
Thyroid disorders
Pituitary gland conditions such as prolactinoma
Significant weight loss or eating disorders
Excessive exercise
Hormonal contraception
Chronic illness
Congenital abnormalities affecting the reproductive system
Symptoms
Amenorrhoea itself is a symptom, but other symptoms may help identify the underlying cause.
Possible associated symptoms include:
Acne or oily skin
Excess facial or body hair
Weight changes
Hot flushes or night sweats
Vaginal dryness
Pelvic pain or pressure
Headaches or vision changes
These symptoms may suggest conditions such as PMOS, POI, or thyroid disease.
Effects on Fertility
Diagnosis
Diagnosing the cause of primary amenorrhoea or secondary amenorrhoea involves assessing symptoms, hormone levels and reproductive anatomy.
Assessment may include:
Detailed menstrual and medical history
Lifestyle, exercise and stress review
Physical examination
Blood tests to assess hormone levels and endocrine function
Pelvic ultrasound to examine the uterus and ovaries
MRI scanning if pituitary disease is suspected
Blood tests may assess:
Follicle-stimulating hormone (FSH)
Luteinizing hormone (LH)
Oestrogen
Prolactin
Thyroid function
Insulin levels
Sex hormone-binding globulin (SHBG)
Treatments
Treatment depends on the underlying cause, symptoms and fertility goals.
Hormonal treatment
Hormone replacement therapy (HRT)
Treatment for hormonal imbalance
Lifestyle treatment
Nutritional support
Addressing eating disorders
Reducing excessive exercise
Stress management
Medical treatment
For underlying conditions such as:
Thyroid disease
Pituitary tumours
Adrenal disorders
If pregnancy is desired, fertility treatment may also be recommended.
Ongoing Care
Living with the Condition
When to See a Specialist
You should seek specialist advice if:
Periods have not started by age 15–16
Periods stop for three months or longer
Previously irregular cycles stop completely
You develop symptoms such as excess hair growth, hot flushes or other hormonal changes
Early assessment can help identify the cause and reduce the risk of complications affecting fertility, hormonal health, bone health and long-term wellbeing.