Amenorrhea is the absence of your menstrual periods. It is a sign that there may be an underlying medical condition, and the accompanying symptoms depend on the cause.
By treating the condition causing amenorrhea, menstrual periods usually resume. Additionally, maintaining a healthy lifestyle is essential, as in many cases this helps not only to restore your cycle but also your fertility.
What is amenorrhea and how is it classified?
Amenorrhea is the lack of menstruation and is divided into:
- Primary amenorrhea: when a woman over 16 years old has not yet had her first period.
- Secondary amenorrhea: when a woman who previously had regular cycles stops menstruating for 3 months or more. The most common cause is pregnancy, followed by polycystic ovary syndrome.
It affects between 2% and 5% of women in the U.S., though it is normal in girls under 16, in women over 45, or during pregnancy.
What symptoms can accompany amenorrhea?
Amenorrhea reflects an underlying problem, so the signs can be very varied:
- Delayed development of pubic hair or breasts
- Chronic pelvic pain or pain during intercourse
- Hot flashes, low libido, irritability, and mood swings
- Milk discharge (galactorrhea), headache, or vision problems
- Weight gain or loss, swelling, tachycardia, or bradycardia
- Depression, anxiety, difficulty concentrating, or tremors
- Hirsutism, acne, skin spots, very dry skin, or brittle nails
- Infertility
If you notice any of these symptoms, consult a reproductive specialist as soon as possible.
What are the most frequent causes of amenorrhea?
Primary amenorrhea is influenced by hormonal imbalances in the hypothalamus, pituitary gland, or ovaries, malformations of the reproductive tract, or an imperforate hymen.
Secondary amenorrhea can be due to uterine curettage, hormonal disorders (e.g., polycystic ovary syndrome), contraceptive methods (IUD or oral), stress, eating disorders, excessive exercise, weight changes, certain medications, or treatments such as chemotherapy.
Other associated conditions:
- Pelvic adhesions, anovulation, or premature ovarian failure
- Hyperprolactinemia or thyroid disorders
- Uterine malformations, fibroids, or intrauterine adhesions
- Obesity or insulin resistance
- Polycystic ovary syndrome
How is the cause of amenorrhea diagnosed?
The diagnosis includes a pelvic exam, your medical history, and tests such as:
- Blood tests to measure ovarian hormones (estrogen, progesterone), pituitary hormones (LH, FSH, TSH, prolactin), and hypothalamic hormones (GnRH).
- Transvaginal ultrasound to rule out malformations, fibroids, or adhesions.
- MRI or CT scan of the brain if a pituitary adenoma is suspected.
What treatments exist for amenorrhea and improving fertility?
- Medications to balance your hormones and correct insulin resistance.
- Ovulation induction with clomiphene citrate or gonadotropins, always under medical supervision.
- In vitro fertilization (IVF) when ovarian stimulation is not sufficient.
- IVF with egg donation, with success rates of up to 60%.
- Surgery to remove pituitary tumors or uterine adhesions.
- Healthy lifestyle recommendations to maximize results.
If natural conception is not possible, consider adoption or surrogacy as alternatives.
Do not self-medicate: before taking any medication, consult a reproductive specialist, especially if you are looking to increase your chances of pregnancy.
If you believe your amenorrhea may be related to endometriosis or hyperthyroidism, your doctor will help you take a comprehensive approach.
FAQ about amenorrhea and fertility
Can amenorrhea affect my chances of getting pregnant?
Yes. By disrupting ovulation or the thickness of the endometrium, amenorrhea reduces the chances of spontaneous pregnancy. However, with proper diagnosis and treatment, many women achieve conception.
How long does it take to restore menstruation after treatment?
It depends on the cause. In functional amenorrhea due to stress or weight loss, the cycle may return in 1–3 months as habits improve. With hormonal treatments, it usually takes between 2 and 6 months.
Is it normal to have amenorrhea and then menstruate again without intervention?
In cases of extreme stress, intense exercise, or very restrictive diets, it can happen when you normalize your lifestyle. But if your period does not return within 3 months, consult a specialist.
What hormonal tests are ordered for amenorrhea?
Generally, ovarian hormones (estradiol, progesterone), pituitary hormones (FSH, LH, prolactin), and thyroid hormones (TSH) are measured, as well as GnRH to rule out hypothalamic causes.
Sources
- American College of Obstetricians and Gynecologists. (2021). Amenorrhea.
- MedlinePlus. (2022). Amenorrhea.
- Practice Committee of the American Society for Reproductive Medicine. (2015).
- World Health Organization. (2018). Medical eligibility criteria for contraceptive use.
We want to support you on this journey. If you have questions or need guidance, do not hesitate to seek professional help. A reproductive specialist will provide the personalized care you deserve.