Amenorrhea is the absence or abnormal cessation of the menses in a woman of reproductive age. Physiological states of amenorrhoea are seen, most commonly, during pregnancy and lactation (breastfeeding), the latter also forming the basis of a form of contraception known as the lactational amenorrhoea method. Outside of the reproductive years there is absence of menses during childhood and after menopause. Determining the cause of your amenorrhoea is necessary in order to begin appropriate management. Your doctor will need to ask for detailed information regarding your general health, sexual and physical development, diet and exercise habits as well as inquire about any family history of similar problems. Your doctor may also need to perform a physical examination, which may include the breasts (to check for normal development) and the pelvis (to look for any obvious abnormalities). In addition to this, you may be required to have a blood test, to look at hormone levels in the blood (including pregnancy hormones, FSH, LH, testosterone, prolactin and thyroid), and imaging studies such as an ultrasound of the pelvis or a scan of the head or pelvis.

There are two primary ways to classify amenorrhoea. Types of amenorrhoea are classified as primary or secondary, or based on functional "compartments". The latter classification relates to the hormonal state of the patient that hypo-, eu-, or hypergonadotropic (whereby interruption to the communication between gonads and follicle stimulating hormone - FSH causes FSH levels to be either low, normal or high).

A)    Classification by primary vs. secondary type:  

  • Primary amenorrhoea is the absence of menstruation in a woman by the age of 16. As pubertal changes precede the first period, or menarche, women by the age of 14 who still have not reached menarche, plus having no sign of secondary sexual characteristics, such as thelarche or pubarche—thus are without evidence of initiation of puberty—are also considered as having primary amenorrhoea. 
  • Secondary amenorrhoea is where an established menstruation has ceased—for three months in a woman with a history of regular cyclic bleeding, or nine months in a woman with a history of irregular periods. This usually happens to women aged. However, adolescent athletes are more likely to experience disturbances to the menstrual cycle than athletes of any other age. Amenorrhoea may cause serious pain in the back near the pelvis and spine. This pain has no cure, but can be relieved by a short course of progesterone to trigger menstrual bleeding.

B)    Classification by compartment: the reproductive axis can be viewed as having four compartments: 

  1. outflow tract (uterus, cervix, vagina), 
  2. ovaries, 
  3. pituitary gland, and 
  4. hypothalamus. 
        Pituitary and hypothalamic causes are often grouped together.

Treatment goals include the prevention of complications such as osteoporosis and endometrial hyperplasia from the associated abnormal hormone levels, and the preservation of fertility. In many cases of primary amenorrhea, treatment should be started immediately following the diagnosis, with the primary therapeutic goal being to facilitate normal secondary sexual development. Key issues are problems of surgical correction if appropriate and oestrogen therapy if oestrogen levels are low. For those who do not plan to have biological children, treatment may be unnecessary if the underlying cause of the amenorrhoea is not threatening to their health. However, in the case of athletic amenorrhoea, deficiencies in estrogen and leptin often simultaneously result in bone loss, potentially leading to osteoporosis. In general, the treatment of amenorrhea must be patient-tailored according to the causative factor.

Associated diseases 


Risk factors 

Amenorrhoea may have a very negative impact on fertility. Many women with amenorrhoea are anovulatory. An anovulatory cycle is a menstrual cycle during which the ovaries do not release an oocyte. If ovulation does not take place then of course pregnancy becomes impossible.

Preventing the large stress and excessive physical activity.  

Decreasing the amount and intensity of exercise

"Athletic" amenorrhoea which is part of the female athlete triad (a syndrome in which eating disorders, amenorrhoea/oligomenorrhoea, and decreased bone mineral density - osteoporosis and osteopenia are present) is treated by eating more and decreasing the amount and intensity of exercise. If the underlying cause is the athlete triad then a multidisciplinary treatment including monitoring from a physician, dietitian, and mental health counselor is recommended, along with support from family, friends, and coaches.


Practice of Yoga Nidra is a simple method of relaxation which is practiced in the flat lying position of shavasana (lying on the back, the arms and legs are spread at about 45 degrees), and followings the spoken instruction of yoga therapist. Yoga Nidra can be an effective practice to overcome the psychiatric morbidity associated with menstrual irregularities apart from bringing the hormonal profile towards normalcy. Therefore, Yogic relaxation training (Yoga Nidra) could be prescribed as an adjunct to conventional drug therapy for menstrual dysfunction.


Although oral contraceptives can causes menses to return, oral contraceptives should not be the initial treatment as they can mask the underlying problem and allow other effects of the eating disorder, like osteoporosis, continue to develop. Weight recovery, or increased rest does not always catalyze the return of a menses. Recommencement of ovulation suggests a dependency on a whole network of neurotransmitters and hormones, altered in response to the initial triggers of secondary amenorrhoea. To treat drug-induced amenorrhoea, stopping the medication on the advice of a doctor is a usual course of action.

As for physiological treatments to hypothalamic amenorrhoea, injections of metreleptin (r-metHuLeptin) have been tested as treatment to oestrogen deficiency resulting from low gonadotropins and other neuroendocrine defects such as low concentrations of thyroid and IGF-1. R-metHuLeptin has appeared effective in restoring defects in the hypothalamic-pituitary-gonadal axis and improving reproductive, thyroid, and IGF hormones, as well as bone formation, thus curing the amenorrhoea and infertility. However, it has not proved effective in restoring of cortisol and adrenocorticotropin levels, or bone resorption.

Looking at hypothalamic amenorrhoea, studies have provided that the administration of a selective serotonin reuptake inhibitor (SSRI) might correct abnormalities of Functional hypothalamic Amenorrhoea (FHA) related to the condition of stress-related amenorrhoea. This involves the repair of the PI3K signaling pathway, which facilitates the integration of metabolic and neural signals regulating gonadotropin releasing hormone (GnRH)/luteinizing hormone (LH). In other words, it regulates the neuronal activity and expression of neuropeptide systems that promote GnRH release. However, SSRI therapy represents a possible hormonal solution to just one hormonal condition of hypothalamic amenorrhoea. Furthermore, because the condition involves the inter workings of many different neurotransmitters, much research is still to be done on presenting hormonal treatment that would counteract the hormonal affects.

Surgical therapy 

Surgical therapy for amenorrhoea is not common, but may be recommended in some conditions (uterine scarring, pituitary tumor).

Amenorrhoea remains a clinically challenging entity because in vitro fertilisation (IVF) with donor oocytes is currently the only treatment known to be effective. Most such IVF patients will conceive from treatment using oocytes from an anonymous oocyte donor. As with all types of donor gamete therapy, pre-treatment counselling is very important. 

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Amenorrhoea ―sourced from Wikipedia licensed under CC BY-SA 3.0
Amenorrhoea ―sourced from Queensland Government licensed under CC BY 3.0 AU
Ovulation ―sourced from Wikipedia licensed under CC BY-SA 3.0
Female athlete triad ―sourced from Wikipedia licensed under CC BY-SA 3.0
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