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Amenorrhea: Absence of Menstruation

The menstrual cycle is regulated by the hypothalamus, a portion of the brain that also controls body temperature, appetite and blood pressure. The hypothalamus stimulates the pituitary gland (located near the base of the brain) to release hormones that regulate female reproductive cycling. In order for a woman to have regular menstrual cycles, her hypothalamus and pituitary gland must be functioning properly. Her cervix and vagina must also be anatomically normal to allow the passage of menstrual flow.

A problem with any of these parts of the body may keep you from having a period.

Amenorrhea means that a woman of childbearing age fails to have her monthly periods. Amenorrhea may be primary (also called "delayed menarche") or secondary. Primary amenorrhea occurs when a woman has not her first menstrual period by age 16. Primary amenorrhea is most often due to late puberty, which is fairly common in teen-age girls who are very thin or very athletic. Sometimes it results from a hormonal problem, a genetic disorder, or birth defect.

Secondary amenorrhea, on the other hand, occurs when a woman who has menstruated previously fails to menstruate for three or more months in a row. It can be caused by:

Pregnancy and breast-feeding (lactation)

Menopause (the normal age-related end of menstruation)

Hysterectomy (surgical removal of the uterus)

Stopping birth-control pills

Tumors of the pituitary gland

Cysts or tumors in the ovaries

Brain tumor or injury

Thyroid problems

Chronic illness, such as colitis, kidney failure or cystic fibrosis

Emotional or physical stress

Malnutrition or obesity

Frequent strenuous exercise

Chemotherapy

Radiation therapy

Drugs, such as tranquilizers and antidepressants

Heavy smoking

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Not having menstrual periods is a symptom, not a disease. Women with amenorrhea may have absent periods, acne, increased facial hair, decreased pubic and armpit hair, deeper voice, decreased breast size, weight gain, and secretions from the breast.

Amenorrhea rarely is caused by a life-threatening condition. In most instances, symptoms and conditions related to amenorrhea are reversible and treatable.

In many cases, teenage girls can help prevent primary amenorrhea by maintaining a normal weight for their height and age, and following a sensible exercise program. Primary amenorrhea caused by anatomic abnormalities of the reproductive tract usually cannot be prevented.

On the other hand, preventing secondary amenorrhea can be done by maintaining a healthy lifestyle.

Eat a low-fat diet that meets your recommended daily nutritional needs.

Exercise moderately, but not excessively.

Avoid excessive alcohol consumption, mood-altering stimulants or sedative drugs and cigarette smoking.

Find healthy outlets for emotional stress and daily conflicts.

If you miss more than two periods in a row, consult with your health care provider immediately.

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