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What causes Amenorrhea?

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Amenorrhea can happen for many reasons. It most often occurs as a natural part of life, such as during pregnancy or breastfeeding, but it can also signal a more serious condition.

What causes primary amenorrhea?

There are three main causes of primary amenorrhea:

  • Chromosomal or genetic abnormalities can cause the ovaries to stop functioning normally. Turner syndrome, a condition caused by a partially or completely missing X chromosome, and androgen insensitivity syndrome, often characterized by high levels of testosterone, are two examples of genetic abnormalities that can delay or disrupt menstruation.1
  • Hypothalamic (pronounced hahy-poh-thuh-LAM-ik) or pituitary (pronounced pi-TOO-i-ter-ee) problems in the brain and physical problems such as problems with reproductive organs can prevent periods from starting.
  • Excessive exercise, eating disorders, extreme physical or psychological stress, or a combination of these factors can delay the onset of menstruation.

What causes secondary amenorrhea?

Secondary amenorrhea can result from various causes, such as:

  • Natural causes.
    • Pregnancy is the most common cause.
    • Other natural causes include breastfeeding and menopause.
  • Medications and therapies.
    • Certain birth control pills, injectable contraceptives, and intrauterine devices (IUDs) can cause amenorrhea. It can take a few months after stopping birth control for the menstrual cycle to restart and become regular.
    • Some medications, including certain antidepressants and blood pressure medications, can increase the levels of a hormone that prevents ovulation and the menstrual cycle.2
    • Chemotherapy and radiation treatments for hematologic cancer (including blood, bone marrow, and lymph nodes) and breast or gynecologic cancer can destroy estrogen-producing cells and eggs in the ovaries, leading to amenorrhea. The resulting amenorrhea may be short-term, especially in younger women.3
    • Sometimes scar tissue can build up in the lining of the uterus, preventing the normal shedding of the uterine lining in the menstrual cycle. This scarring sometimes occurs after a dilation and curettage (D&C), a procedure in which tissue is removed from the uterus to diagnose or treat heavy bleeding or to clear the uterine lining after a miscarriage,4 a cesarean section, or treatment for uterine fibroids.
  • Hypothalamic amenorrhea. This condition occurs when the hypothalamus, a gland in the brain that regulates body processes, slows or stops releasing gonadotropin-releasing hormone (GnRH), the hormone that starts the menstrual cycle.5 Common characteristics of women with hypothalamic amenorrhea include:6
    • Low body weight
    • Low percentage of body fat
    • Very low intake of calories or fat
    • Emotional stress
    • Strenuous exercise that burns more calories than are taken in through food
    • Deficiency of leptin, a protein hormone that regulates appetite and metabolism
    • Some medical conditions or illnesses
  • Gynecological conditions. Unbalanced hormone levels are common features of certain conditions that have secondary amenorrhea as a main symptom. These can include:
    • Polycystic ovary syndrome (PCOS). PCOS occurs when a woman's body produces more androgens (a type of hormone) than normal. High levels of androgens can cause fluid-filled sacs or cysts to grow in the ovaries, interfering with the release of eggs (ovulation). Most women with PCOS either have amenorrhea or experience irregular periods, called oligomenorrhea (pronounced ol-i-goh-men-uh-REE-uh).
    • Fragile X-associated primary ovarian insufficiency (FXPOI). The term FXPOI describes a condition in which a woman's ovaries stop functioning before normal menopause, sometimes around age 40. FXPOI results from certain changes to a gene on the X chromosome. As many as 10% of women who seek treatment for amenorrhea have FXPOI.7
  • Thyroid problems. The thyroid is a small butterfly-shaped gland at the base of the neck, just below the Adam's apple. The thyroid produces hormones that control metabolism and play a role in puberty and menstruation.8 A thyroid gland that is overactive (called hyperthyroidism) or underactive (hypothyroidism) can cause menstrual irregularities, including amenorrhea.9
  • Pituitary tumor. Noncancerous tumors in the pituitary gland in the brain, which regulates the production of hormones that affect many body functions, including metabolism and the reproductive cycle, can interfere with the body's hormonal regulation of menstruation.10

  1. Pascal, P., Leprieur, E., Zenaty, D., Thibaud, E., Polak, M., Frances, A.M., et al. (2010). Steroidogenic factor-1 (SF-1) gene mutation as a frequent cause of primary amenorrhea in 46,XY female adolescents with low testosterone concentration. Reproductive Biology and Endocrinology, 8(28): 1-6. Lin, K & Barnhart, K. (2007). The clinical rationale for menses-free contraception. Journal of Women's Health, 16(8), 1171-1180. [top]
  2. La Torre, D., & Falorni, A. (2007). Pharmacological causes of hyperprolactinemia. Therapeutic and Clinical Risk Management, 3, 929–951. Retrieved May 14, 2012, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2376090/ [top]
  3. American College of Obstetricians and Gynecologists (ACOG). (2011). ACOG Committee Opinion: Primary ovarian insufficiency in the adolescent. Retrieved May 14, 2012, from http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Adolescent_Health_Care/Primary_Ovarian_Insufficiency_in_the_Adolescent External Web Site Policy [top]
  4. ACOG. (2012). Dilation and curettage. Retrieved June 6, 2012, from http://www.acog.org/~/media/For%20Patients/faq062.pdf?dmc=1&ts=20120606T1418144478 External Web Site Policy [top]
  5. Gordon, C. M. (2010). Functional hypothalamic amenorrhea. New England Journal of Medicine, 363, 365−371. [top]
  6. Hormone Health Network. (n.d.). Amenorrhea. Retrieved May 14, 2012, from http://www.hormone.org/Reproductive/amenorrhea.cfm External Web Site Policy [top]
  7. ACOG. (2011). ACOG Committee Opinion: Primary ovarian insufficiency in the adolescent. Retrieved May 14, 2012, from http://www.acog.org/Resources_And_Publications/Committee_Opinions/Committee_on_Adolescent_Health_Care/Primary_Ovarian_Insufficiency_in_the_Adolescent External Web Site Policy [top]
  8. U.S. Department of Health and Human Services Office of Women's Health. (2010). Thyroid disease fact sheet. Retrieved May 27, 2012, from http://womenshealth.gov/publications/our-publications/fact-sheet/thyroid-disease.html [top]
  9. Master-Hunter, T., & Heiman, D. L. (2006). Amenorrhea: Evaluation and treatment. American Family Physician. 73, 1374−1382. Retrieved April 6, 2012, from http://www.aafp.org/afp/2006/0415/p1374.html External Web Site Policy [top]
  10. Master-Hunter, T., & Heiman, D. L. (2006). Amenorrhea: Evaluation and treatment. American Family Physician. 73, 1374−1382. Retrieved April 6, 2012, from http://www.aafp.org/afp/2006/0415/p1374.html External Web Site Policy [top]

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Last Updated Date: 05/07/2013
Last Reviewed Date: 03/03/2013
Vision National Institutes of Health Home BOND National Institues of Health Home Home Storz Lab: Section on Environmental Gene Regulation Home Machner Lab: Unit on Microbial Pathogenesis Home Division of Intramural Population Health Research Home Bonifacino Lab: Section on Intracellular Protein Trafficking Home Lilly Lab: Section on Gamete Development Home Lippincott-Schwartz Lab: Section on Organelle Biology