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Amenorrhoea

Amenorrhoea means the absence of menstrual periods. This may happen when periods never start during adolescence, or when periods stop for several months after previously being regular. While missing periods can sometimes be normal, they may also indicate an underlying hormonal or reproductive health condition.

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

  • Polycystic ovarian syndrome (PCOS)

  • Primary ovarian insufficiency (POI)

  • Functional hypothalamic amenorrhoea

  • 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 PCOS, POI, or thyroid disease.

Effects on Fertility

Amenorrhoea can affect fertility because the absence of regular menstrual cycles may prevent ovulation. Some underlying causes, such as POI or PCOS, may make conception more difficult.


Early diagnosis and appropriate treatment can help support reproductive health and fertility planning.

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 may include:

  • Hormone replacement therapy (HRT)

  • Hormonal contraception to regulate periods

  • Treatment for hormonal imbalance


Lifestyle treatment may include:

  • Nutritional support

  • Addressing eating disorders

  • Reducing excessive exercise

  • Stress management


Medical treatment may also be needed for underlying conditions such as:

  • Thyroid disease

  • Polycystic ovarian syndrome

  • 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.

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