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Amenorrhea (absence of menstruation)

Reviewed by , DO

Amenorrhea, or skipping multiple periods, may seem like a benign — or perhaps even convenient — problem, and it can be. However, in some cases, amenorrhea can lead to more significant health issues over time in terms of fertility, bone health and cancer risk. For those reasons alone, you shouldn’t ignore amenorrhea.

A woman looks at a calendar to track her missing period

Over their reproductive years, most women will miss a period or two now and again, especially during times of stress — holidays, deadlines, changes in relationships, grieving, and traveling, for example. Just about any blip in your routine can cause you to have an anovulatory cycle when you don’t produce an egg. This is a perfectly natural biological response because if your life is off- kilter, it may not be an ideal time for you to get pregnant.

It’s different if you’re skipping periods on an ongoing basis. That’s a clear sign there is an underlying imbalance that is more profound, one that is disturbing your monthly cycle. Something is going on beneath the surface, and it’s important to know what type of amenorrhea you may be experiencing and what it can signify.

Two types of amenorrhea

Amenorrhea is a diagnostic term meaning the absence of menstruation, generally referring to women who are not pregnant with any of these menstrual descriptions:

  • have missed more than three consecutive periods
  • are spotting during their cycles
  • get their periods very infrequently

Primary amenorrhea is the term used to describe the complete absence of periods in a woman who has never had regular menstrual cycles, or when the onset of menses (menarche) is delayed beyond 15 years of age with normal sexual development otherwise. Primary amenorrhea is quite uncommon and is often associated with an underlying medical condition, such as reproductive abnormalities, enzyme deficiencies, or chromosomal abnormalities. All of these need consultation and treatment by a specialist.

Secondary amenorrhea describes the absence of menstruation in either of these situations:

  • You’ve previously menstruated on a regular basis but have missed periods for three months.
  • You’ve previously experienced irregular periods and have skipped your periods for six months.

The causes of secondary amenorrhea are estrogen-related — usually either very high or very low levels — with a corresponding lack of ovulation (anovulation). Polycystic ovarian syndrome (PCOS), a hormonal imbalance related to insulin resistance, can cause months of amenorrhea followed by extremely heavy bleeding (menorrhagia) due to excessively high estrogen levels.

The most common form of amenorrhea

The amenorrhea doctors see most is hypothalamic amenorrhea, when the body reverts to survival mode because it cannot sustain reproductive mode. This condition develops when poor nutrition or extreme stress alters the normal signaling to the brain that regulates the menstrual cycle. Women with this condition may be severely restricting their caloric intake, exercising excessively or under major psychological stress.

We see it most commonly in performance athletes or dancers, for example, as well as in women with anorexia nervosa. In these situations, the brain doesn’t get adequate energy or the macronutrients necessary to produce the hormones for follicle ripening and release of eggs. This root cause of anovulation responds well to natural treatments for amenorrhea.

Certain forms of birth control pills and IUDs (like Mirena) can also cause absent periods or a noticeable decrease in menstrual flow. While you should mention this effect to your healthcare provider, it isn’t rare. It’s also quite different from having infrequent, spotty or skipped periods with no known cause. Generally, as long as your flow is cyclic — whatever pattern it takes — it is considered regular and not particularly worrisome.

In some cases, amenorrhea is a symptom of hormonal imbalance due to perimenopause or insulin resistance, as in the case of PCOS. With PCOS, progesterone support can sometimes help jump-start regular cycling again. Remember, unless you are pregnant, nursing, or experiencing other serious health concerns, menopause is official after 12 consecutive months without having a period.

Reversing amenorrhea

In essence, amenorrhea is a signal of underlying hormonal imbalance that should not be dismissed. In the long term it can lead to more significant, even irreversible health conditions, such as osteoporosis. But we advise you to investigate early on because there is a lot you can do to help with amenorrhea:

happy woman smiling

1. Examine your lifestyle for unusual stress factors, including extreme diet and exercise habits, as either can be the cause of your missed periods.
2. Talk to your healthcare practitioner and get a pelvic exam to rule out any abnormalities. You may also want to request a hormone panel to test your levels of GnRH, FSH, LH, estrogen, prolactin and TSH.
3. Seek counseling as soon as possible if you suspect there are psychological issues underpinning your amenorrhea.

Women’s bodies are remarkably resilient. Menstrual cycles often normalize just by optimizing nutrition, reducing physical stress, and clearing emotional blocks. Chances are good that yours will, too.


1 Ahima, R. 2004. Body fat, leptin, and hypothalamic amenorrhea. NEJM, 351 (10), 959–962.

Frisch R. 1990. The right weight: Body fat, menarche and ovulation. Baillieres Clin. Obstet. Gynaecol., 4 (3), 419–439.

Last Updated: February 27, 2023
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