BACK
TO
TOP
Browse A-Z
Print-Friendly
Bookmarks
bookmarks-menu

Absent menstrual periods - secondary

Amenorrhea - secondary; No periods - secondary; Absent periods - secondary; Absent menses - secondary; Absence of periods - secondary

Absence of a woman's monthly menstrual period is called amenorrhea. Secondary amenorrhea is when a woman who has been having normal menstrual cycles stops getting her periods for 6 months or longer.

Causes

Secondary amenorrhea can occur due to natural changes in the body. For example, the most common cause of secondary amenorrhea is pregnancy. Breastfeeding and menopause are also common, but natural causes.

Women who take birth control pills or who receive hormone shots such as Depo-Provera may not have any monthly bleeding. When they stop taking these hormones, their periods may not return for more than 6 months.

You are more likely to have absent periods if you:

  • Are obese
  • Exercise too much and for long periods of time
  • Have low body fat (less than 15% to 17%)
  • Have severe anxiety or emotional distress
  • Lose a lot of weight suddenly (for example, from strict or extreme diets or after gastric bypass surgery)

Other causes include:

Also, procedures such as a dilation and curettage (D and C) can cause scar tissue to form. This tissue may cause a woman to stop menstruating. This is called Asherman syndrome. Scarring may also be caused by some severe pelvic infections.

Symptoms

In addition to having no menstrual periods, other symptoms can include:

  • Breast size changes
  • Weight gain or weight loss
  • Discharge from the breast or change in breast size
  • Acne and increased hair growth in a male pattern
  • Vaginal dryness
  • Voice changes

If amenorrhea is caused by a pituitary tumor, there may be other symptoms related to the tumor, such as vision loss and headache.

Exams and Tests

A physical exam and pelvic exam must be done to check for pregnancy. A pregnancy test will be done.

Blood tests may be done to check hormone levels, including:

Other tests that may be performed include:

Treatment

Treatment depends on the cause of amenorrhea. Normal monthly periods most often return after the condition is treated.

A lack of menstrual period due to obesity, vigorous exercise, or weight loss may respond to a change in exercise routine or weight control (gain or loss, as needed).

Outlook (Prognosis)

The outlook depends on the cause of amenorrhea. Many of the conditions that cause secondary amenorrhea will respond to treatment.

When to Contact a Medical Professional

See your primary health care provider or women's health care provider if you have missed more than one period so you can get diagnosed and treated, if needed.

Open References

References

Bulun SE. Physiology and pathology of the female reproductive axis. In Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, et al. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 17.

Cameron S. Menstruation and amenorrhoea. In: Magowan B, ed. Clinical Obstetrics and Gynaecology. 5th ed. Elsevier; 2023:chap 4.

Lobo RA. Primary and secondary amenorrhea and precocious puberty. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 36.

  • Secondary amenorrhea

    Secondary amenorrhea - illustration

    Secondary amenorrhea is the cessation of menstrual flow for a period of 6 months or more in the absence of pregnancy, breastfeeding or menopause. Extreme weight gain or loss, certain medications, as well as anxiety can be the root cause of amenorrhea. Treatment can range from behavior modification for excessive exercise to medication to surgery in the presence of disease.

    Secondary amenorrhea

    illustration

  • Normal uterine anatomy (cut section)

    Normal uterine anatomy (cut section) - illustration

    The uterus is a muscular organ with thick walls, two upper openings to the fallopian tubes and an inferior opening to the vagina.

    Normal uterine anatomy (cut section)

    illustration

  • Absence of menstruation (amenorrhea)

    Absence of menstruation (amenorrhea) - illustration

    Amenorrhea is the lack of menstrual flow and can be a normal occurrence or a sign of malfunction or disease. In primary amenorrhea, menstruation does not begin when expected (by the age of 16). Secondary amenorrhea occurs when the normal established menstrual cycle is shut down for 6 or more months due to a condition other than pregnancy, breastfeeding or menopause.

    Absence of menstruation (amenorrhea)

    illustration

  • Secondary amenorrhea

    Secondary amenorrhea - illustration

    Secondary amenorrhea is the cessation of menstrual flow for a period of 6 months or more in the absence of pregnancy, breastfeeding or menopause. Extreme weight gain or loss, certain medications, as well as anxiety can be the root cause of amenorrhea. Treatment can range from behavior modification for excessive exercise to medication to surgery in the presence of disease.

    Secondary amenorrhea

    illustration

  • Normal uterine anatomy (cut section)

    Normal uterine anatomy (cut section) - illustration

    The uterus is a muscular organ with thick walls, two upper openings to the fallopian tubes and an inferior opening to the vagina.

    Normal uterine anatomy (cut section)

    illustration

  • Absence of menstruation (amenorrhea)

    Absence of menstruation (amenorrhea) - illustration

    Amenorrhea is the lack of menstrual flow and can be a normal occurrence or a sign of malfunction or disease. In primary amenorrhea, menstruation does not begin when expected (by the age of 16). Secondary amenorrhea occurs when the normal established menstrual cycle is shut down for 6 or more months due to a condition other than pregnancy, breastfeeding or menopause.

    Absence of menstruation (amenorrhea)

    illustration

A Closer Look

 
 

Review Date: 4/16/2024

Reviewed By: John D. Jacobson, MD, Professor Emeritus, Department of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. No warranty of any kind, either expressed or implied, is made as to the accuracy, reliability, timeliness, or correctness of any translations made by a third-party service of the information provided herein into any other language. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
© 1997- adam.comAll rights reserved.

 
 
 

 

 

A.D.A.M. content is best viewed in IE9 or above, Firefox and Google Chrome browser.
Content is best viewed in IE9 or above, Firefox and Google Chrome browser.