Amenorrhea: When the period is absent


No more menstrual bleeding? During pregnancy or menopause, amenorrhea (absence of period) is completely normal. Outside these times, a variety of conditions, diseases and disorders can trigger the menstrual disorder. More about causes and treatment options here.

During pregnancy or menopause ( menopause ) is the absence of menstruation quite normal. In the fertile years, however, it is considered a menstrual disorder when the period is absent. About three to five percent of women of sexually mature age are affected. Doctors distinguish between a primary and a secondary amenorrhea:

  • In the case of primary amenorrhoea , beyond the age of 16, no menstrual period has yet begun.
  • secondary amenorrhea occurs when menstruation fails to appear at least three months, but the woman had previously been periods.

Amenorrhea: What causes behind it?

During pregnancy, breast-feeding and when menopause occurs , amenorrhea is completely normal. If none of these reasons are present, there are often congenital causes or hormones that have become confused, behind the absence of the period.


Chromosomal disorders are responsible for a primary amenorrhea in a third of cases, for example Turner syndrome , Klinefelter syndrome or Swyer syndrome. In two-thirds of the cases there is an organic disorder behind it: Not fully developed ovaries, a blocked cervix or a completely closed hymen (hymen) prevent a regular menstrual bleeding. Hormonal imbalances can also trigger amenorrhoea, including hypothyroidism or polycystic ovarian syndrome (PCO). In rare cases, primary amenorrhoea is a concomitant of conditions such as cancer or diabetes .

Secondary amenorrhoea often have a spiritual background. That’s because hormones control the menstrual cycle. These are in turn regulated by the brain . If the menstrual period stops, the causes are often found in the hormone-producing or controlling areas of the brain: hypopyphosis, hypothalamus, and thus also in the metabolism. This is susceptible to stress, because so-called stress hormones are released by mental stress, which can disturb the hormonal interaction sensitively. Typical mental causes of a secondary amenorrhea are:

  • Stress all the way to burnout
  • severe weight changes due to frequent diets and underweight due to anorexia
  • excessive sports or other extreme situations ( trekking in the Himalayas, strenuous procession)

But some medications can cause amenorrhea. For example, there is the so-called post-pill amenorrhoea, which occurs after the discontinuation of the anti-baby pill. Antidepressants, antihypertensives and chemotherapy can also lead to a missed period. As with primary amenorrhea, hormonal imbalances may be the trigger for secondary amenorrhoea. Pathological changes in the uterus (for example, endometriosis ) or a hormone-producing tumor of the ovaries or the pituitary gland are very rarely the cause of amenorrhea.

Symptoms of amenorrhea

Menstruation is part of the woman’s cycle, with which her body prepares for pregnancy month after month. If this does not happen, the body repels the endometrium – the periodic bleeding is colloquially called “period” or “rule”. The first menstrual period is called menarche and usually occurs between the ages of 11 and 14, with the last menstruation taking place at the age of 51 on average.

The main symptom of amenorrhea is the absence of the menstrual period. Depending on the cause of amenorrhea, other symptoms sometimes appear:

  • Changes in breast size
  • milky secretions from the breast
  • weight fluctuations
  • acne
  • increased hair growth on the face
  • hair loss
  • Headache or blurred vision
  • vaginal dryness
  • deeper voice

Investigations in amenorrhea

If menstruation lasts longer than three months, a doctor’s visit is necessary. The attending gynecologist will rule out pregnancy and the onset of menopause first. In a detailed interview ( anamnesis ), he then goes to the following, inter alia, the following questions:

  • When did the first menstrual period take place?
  • Was the period always regular?
  • When did the last normal period occur?
  • How long is the cycle usually?
  • How long and hard is the bleeding usually?
  • Does the sufferer suffer from cyclical breast tenderness and mood swings ?
  • Has there been heavy weight fluctuations?
  • How much sport does the person affected do?
  • Are there other symptoms?
  • Are there chronic diseases (also in the family)?
  • Which medications are taken?
  • What is the stress level?

By anamnesis , gynecological examination, ultrasound and determination of the hormonal status can already be clarify 95 percent of amenorrhea. To determine hormone status, a blood sample is used to determine FSH, TSH, LH, prolactin and testosterone levels. If a primary amenorrhoea is suspected, a genetic test may be performed. An examination of the abdomen or uterus provides information about irregularities in the abdominal and pelvic cavities, and magnetic resonance imaging ( MRI ) or computed tomography can detect malformations or tumors.

Treat amenorrhea – there are these possibilities

The treatment of amenorrhoea depends on the underlying clinical picture.

  • In a hormonal disorder corresponding hormone preparations are prescribed. The cycle then regulates and the menstrual period returns. Even a desire to have children can be fulfilled so often.
  • Tumors or malformations of the genital organs can often only get under control with surgery.
  • If a Y chromosome is present, doctors recommend surgical removal of the ovaries because of the increased risk of cancer.

If the primary or secondary amenorrhea is due to the lifestyle, the following measures are recommended:

  • Regulation of overweight or underweight
  • moderate sport
  • stress reduction
  • Psychotherapy helps you get eating disorders and mental stress better grip. With the balanced emotional balance often regulate the menstrual disorders.