Amenorrhea

What is Amenorrhea?
Amenorrhea is the abnormal absence of menstrual periods. Generally speaking, there are three categories of women who have experienced amenorrhea:

• Women who have never had a menstrual period by age sixteen.
• Women who have not had a period for two to three months or more.
• Women who have irregular periods that may vary from 35 to 90 days.

Determining why a woman over 16 years of age has never had a menstrual period is essential for proper treatment; identifying a reason may involve several blood hormone tests, and possibly referral to an endocrinologist.

Missing periods after regular periods have begun is much more common, especially among college students. Changes in environment, diet, stress, as well as medical problems can cause variability in menstrual cycles.

If you menstruate fewer than four times per year or if you miss three consecutive periods, you need to see a health care provider. If you are sexually active, you should see a provider for a pregnancy test after one missed or late period. You should also see a provider if you notice breast/nipple discharge, or if you notice unusual facial hair or other body hair growth.

Why do missed periods occur?
Some of the factors associated with cessation of periods are:

• stress
• calorie-restricted diet
• eating disorders
• strenuous exercise
• hormone imbalance
• organic disease (e.g.. thyroid disease)
• travel

How is amenorrhea treated?
At Health Services, the general protocol for patients with amenorrhea is as follows:

• Rule out the possibility of pregnancy.
• Examine the patient and perform hormone or other tests as indicated.
• Prescribe a drug that stimulates a menstrual period, if appropriate.
• Consider options for long-term treatment of absent periods such as taking oral contraceptives or taking periodic courses of a progesterone medication.

For most women, these steps are usually enough to bring about normal, regular cycles. Sometimes diagnosis requires more sophisticated testing. Additional treatment may be required to achieve normal cycles and, when desired, pregnancy.

Why treat amenorrhea?
If an estrogen imbalance is causing amenorrhea, it is important to recognize the problem early. Over a long period of time, too much estrogen can cause overgrowth of the cells in the lining of the uterus (endometrial hyperplasia which can lead to cancer), while too little estrogen can cause calcium loss from the bones (leading to osteoporosis).

Important points to remember

• Pregnancy can occur during long periods of amenorrhea.
• Moderation of diet and exercise as well stress reduction are important factors in a regular menstrual cycle.
• Keeping a written record of your menstrual cycle by marking the first day of your period on the calendar is very helpful for your medical provider.

To make an appointment at Health Services, you can call 401.863-3953.

Disclaimer: Health Education is part of Health Services at Brown University. Health Education maintains this site as a resource for Brown students. This site is not intended to replace consultation with your medical providers. No site can replace real conversation. Health Education offers no endorsement of and assumes no liability for the currency, accuracy, or availability of the information on the sites we link to or the care provided by the resources listed.  Health Services staff are available to treat and give medical advice to Brown University students only. If you are not a Brown student, but are in need of medical assistance please call your own health care provider or in case of an emergency, dial 911.  Please contact us if you have comments, questions or suggestions.

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last modified: March 6, 2008