Amenorrhea

Absence of menstruation may be linked to an underlying, treatable condition. Learn about why it happens and when to seek help.

Update Date: 15.09.2026

Overview
Symptoms
When to see a doctor
Causes
Natural amenorrhea
Contraceptives
Medicines
Lifestyle factors
Hormonal imbalance
Structural conditions
Risk factors
Complications
Diagnosis
Blood tests
Progestin challenge test
Imaging tests
Scope tests
Treatment
Self-care
Preparing for your appointment
What you can do
What to expect from your doctor

By Mayo Clinic Staff

Overview

Amenorrhea (uh-men-o-REE-uh) is the lack of a menstrual period, either by never menstruating or missing three or more periods or menstrual cycles.

Primary amenorrhea means no first period by age 15 if other puberty changes are present, or by age 13 if they're not. The most common causes of primary amenorrhea relate to hormone levels, although having reproductive anatomy that isn't typical also can cause amenorrhea.

Secondary amenorrhea occurs when you miss three or more periods in a row when you had periods in the past. It also happens if you had cycles that weren't regular and haven't had a period for more than six months. Pregnancy is the most common cause of secondary amenorrhea, although issues with hormones also can cause secondary amenorrhea.

Treatment of amenorrhea depends on the cause.

Symptoms

Depending on the cause of amenorrhea, you might have other signs or symptoms along with the absence of periods, such as:

  • Milky nipple discharge.
  • Hot flashes.
  • Vaginal dryness.
  • Hair loss.
  • Headache.
  • Vision changes.
  • Excess facial hair.
  • Pelvic pain.
  • Acne.

When to see a doctor

Consult your doctor or other healthcare professional if you've missed at least three menstrual periods in a row; if you've never had a menstrual period and you're 15 years old or older; or if you reach age 13 and don't have other puberty changes.

Causes

Amenorrhea can occur for a variety of reasons. Sometimes the condition is expected, such as if you are pregnant. But other times, the condition may be a side effect of medicines or a sign of a medical condition.

Natural amenorrhea

During your lifetime, you may have amenorrhea for expected reasons, such as:

  • Pregnancy.
  • Breastfeeding.
  • Menopause.

Contraceptives

Hormonal birth control methods such as implants, some pills and levonorgestrel intrauterine devices (IUDs), and shots, also called injections, can cause amenorrhea. Copper IUDs typically do not. Periods may take time to return after stopping hormonal birth control. It may take longer for your periods to return after stopping injections. Talk with your healthcare professional about how long it may take your period to come back after you stop hormonal birth control.

Medicines

Certain medicines can cause menstrual periods to stop, including some types of:

  • Antipsychotics.
  • Cancer chemotherapy.
  • Blood pressure medicines.
  • Opioids.

Lifestyle factors

Sometimes lifestyle factors contribute to amenorrhea, for instance:

  • Stress. Mental stress can, for a limited time, alter the work of the hypothalamus, which is an area of the brain that controls the hormones that direct the menstrual cycle. Ovulation and menstruation may stop as a result. Regular menstrual periods usually start again if stress levels get lower.
  • Not eating enough. Eating too few calories can suppress the hypothalamus and cause amenorrhea.
  • Rigorous exercise. If you participate in activities that require lots of training, such as ballet or long-distance running, you may have amenorrhea. Several factors can play a part in the loss of periods in athletes, including low body fat, stress and needing a lot of calories for physical activity.

Hormonal imbalance

Many types of medical conditions can happen when hormones are not in balance, also called hormonal imbalance. These conditions include:

  • Polycystic ovary syndrome (PCOS). PCOS causes hormone levels to stay mostly the same, rather than going up and down as they do in the typical menstrual cycle.
  • Thyroid conditions. Having an overactive thyroid gland, called hyperthyroidism, or an underactive thyroid gland, called hypothyroidism, can cause changes in the menstrual cycle, including amenorrhea.
  • Pituitary tumor. A noncancerous, also called benign, tumor in the pituitary gland can change the effects of hormones on menstruation.
  • Primary ovarian insufficiency. This condition occurs before age 40 and can result in periods that don't happen often or are absent.

Structural conditions

Conditions related to the reproductive organs themselves also can cause amenorrhea. Examples include:

  • Uterine scarring. Asherman syndrome, a condition in which scar tissue builds up in the lining of the uterus, can sometimes occur after a procedure called dilation and curettage (D&C), after a cesarean section, or after treatment for uterine fibroids. Uterine scarring prevents the typical buildup and shedding of the uterine lining.
  • Lack of reproductive organs. Sometimes, health conditions that happen when an unborn baby, also called a fetus, is developing can lead to missing parts of the reproductive system, such as the uterus, cervix or vagina. If the reproductive system doesn't develop fully, menstrual cycles may not be possible later in life.
  • Structural changes in the vagina. An obstruction of the vagina may prevent visible menstrual bleeding. A membrane or wall may be present in the vagina that keeps blood from leaving the uterus or cervix.

Female reproductive system

The ovaries, fallopian tubes, uterus, cervix and vagina, also called the vaginal canal, make up the female reproductive system.

Risk factors

Factors that may increase your risk of amenorrhea include:

  • Family history. If a first-degree relative, such as a mother or sister, has a history of amenorrhea, you may be more likely to have the condition.
  • Eating disorders. People with eating disorders, such as anorexia or bulimia, have a higher risk of amenorrhea.
  • Severe, long-lasting anxiety. Severe anxiety or other mental health conditions can sometimes cause periods to stop or happen less often. This happens because stress can affect the part of the brain that controls periods.
  • Athletic training. Rigorous athletic training can raise your risk of amenorrhea.
  • History of certain gynecological procedures. If you've had uterine surgery, such as a D&C, your risk of developing amenorrhea is higher.

Complications

The causes of amenorrhea can cause other health conditions too. These include:

  • Infertility. If you don't ovulate, you can't become pregnant without treatment. However, some people who do ovulate may not have a period. This can lead to unplanned pregnancy. A healthcare professional can do tests to help you know whether you ovulate.
  • Psychological stress. Not having periods when other people your age are having them can be stressful, especially if you're a young person moving into adulthood.
  • Osteoporosis. Osteoporosis is a weakening of the bones that low estrogen levels can cause.
  • Pelvic pain. You might have pain in the pelvic area if amenorrhea happens because of a difference in the position or shape of your reproductive organs.

Diagnosis

During your appointment, your healthcare professional may perform a pelvic exam to check your reproductive organs. If you've never had a period, your healthcare professional may look at your breasts and genitals to check for the typical changes of puberty.

Amenorrhea can be a sign of a complex set of hormonal conditions. Finding the underlying cause can take time. You may need more than one kind of testing.

Blood tests

You may need a variety of blood tests, including:

  • Pregnancy test. This will probably be the first test you have done. It can rule out or confirm a possible pregnancy.
  • Thyroid function test. Measuring the amount of thyroid-stimulating hormone in your blood can show whether your thyroid is working as it should.
  • Ovary function test. Looking at the level of follicle-stimulating hormone in your blood helps show how well your ovaries are working.
  • Prolactin test. High levels of the hormone prolactin may be a sign of a pituitary gland tumor.
  • Androgen hormone test. If you have increased facial hair and a lowered voice, you may be checked for the level of androgen hormones in your blood, such as testosterone or androstenedione.

Progestin challenge test

For this test, you take a hormonal medicine for 5 to 10 days to trigger menstrual bleeding. Results from this test can tell your healthcare professional whether your periods have stopped due to a lack of estrogen.

Imaging tests

After getting blood test results, your doctor or other healthcare professional may recommend one or more imaging tests depending on your medical history. Possible imaging tests include:

  • Ultrasound. This test uses sound waves to produce images of internal organs. If you have never had a period, your healthcare professional may suggest an ultrasound test to check for anything that is not typical about your reproductive organs.
  • Magnetic resonance imaging (MRI). MRI uses radio waves with a strong magnetic field to produce very detailed images of soft tissues within the body. Your healthcare professional may order an MRI to check for a pituitary tumor or get more information about the results of an ultrasound.

Scope tests

If other testing reveals no specific cause and there is concern about uterine scarring, your healthcare professional may recommend a hysteroscopy. This is a test in which a thin, lighted tube with a camera on the end is passed through the vagina and cervix to look at the inside of the uterus.

Treatment

Treatment for amenorrhea depends on the underlying cause. Sometimes, birth control pills or other hormone therapies can restart your menstrual bleeding or cycles. Amenorrhea caused by thyroid or pituitary conditions may be treated with medicines. If a tumor or blockage is causing the condition, you may need surgery.

Self-care

Lifestyle factors such as too much exercise or too little food can cause amenorrhea, so strive for balance in work, recreation and rest. Assess areas of stress and conflict in your life and think about ways you might be able to relieve some of that stress. If you can't lower stress on your own, ask for help from family, friends or your healthcare professional.

Watch for changes in your menstrual cycle and check with your doctor or other healthcare professional if you have concerns. Keep a record of when you get your periods. Note the date your period starts and the date that it ends. Also keep track of any troublesome symptoms you may have during your period and the days leading up to it.

Preparing for your appointment

Your first appointment will likely be with your primary healthcare professional or gynecologist.

Here's some information to help you prepare for your appointment and know what to expect from your healthcare professional.

What you can do

To get ready for your appointment:

  • Write down details about your symptoms, including when they started. Also write down the date your last period started, if you know it, and how long that period lasted.
  • Make a note of key medical information, including other conditions for which you're being treated and the names and dosages of any medicines, vitamins and supplements you regularly take.
  • Review your family history, checking to see whether your mother or any sisters also have had conditions related to their periods.
  • Write down questions to ask your healthcare professional, listing the most important ones first.

For amenorrhea, some basic questions to ask your healthcare professional include:

  • What might be causing me to miss my periods?
  • Do I need any tests? How should I prepare for those tests?
  • What treatments are available? Which do you recommend for me?
  • Where can I go to get more information? Do you have any brochures on this topic? What websites do you recommend?

What to expect from your doctor

Your healthcare professional is likely to ask you a number of questions such as:

  • When was your last period?
  • Are you sexually active?
  • Could you be pregnant?
  • Do you use birth control?
  • How would you rate your stress level on a typical day?
  • Have you recently lost or gained weight without trying to? Or have you lost a lot of weight very quickly?
  • How often and how intensely do you exercise?
  • Do you have any other medical conditions?

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