Reproductive Health

Amenorrhea

What is amenorrhea?

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

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

Determining why a person with a uterus 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:

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

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.
Evaluate the possibility of a dietary energy deficit.
Consider options for long-term treatment of absent periods such as taking periodic courses of a progesterone medication.

For most people, 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.

Can I make an appointment at Health Services?

If you are a Brown student and you are concerned about amenorrhea, you can make a confidential appointment at Health Services by calling 401.863-3953. Health Services provides a range of services including general health care, inpatient services and emergency medical care. You can request a medical provider by gender or by name. Health Services is located at 450 Brook Street.