Amenorrhea is the medical term for an absence of menstrual periods. It is described as primary if they have never started, and secondary, when normal menstruation is interrupted for four months or more. Amenorrhea does not necessarily mean you are ill; it does usually mean that you are not producing eggs and so cannot conceive.

What Causes It?

Primary amenorrhea is usually due to late onset of puberty, although it can also be caused by a disorder of the reproductive or hormonal system. The most common reason for secondary amenorrhea is pregnancy. If the hormonal balance is interrupted for any other reason, however, menstrual periods may stop. So, for example, many women who breast-feed find that their periods do not start again until they wean their babies.

More seriously, amenorrhea can be a side effect of being grossly underweight, such as with anorexia nervosa. This will be suspected if your weight is as much as 26lb (12kg) below average for your height and frame. Stress, chronic ailments such as thyroid disease, and long-term medication with drugs such as tranquilizers and antidepressants can also cause amenorrhea, as can excessive physical training.

Amenorrhea is, of course, a permanent condition after menopause, or if you undergo a hysterectomy with removal of your ovaries.

Should I See The Doctor?

The tendency to start menstruation late may be inherited, so if your mother started her periods late, don’t worry if you aren’t developing at the same rate as your friends. However, if you are 16 and have not yet menstruated, contact your doctor to check that there is no abnormality. If your periods suddenly stop, pregnancy could be the cause, so do a pregnancy test first before contacting him. See your doctor if your periods have been absent for six months and you are not pregnant or menopausal.

What Might The Doctor Do?

• If you have never had a menstrual period, your doctor will probably give you a physical examination and take a blood sample to measure the level of pituitary hormones. (The pituitary hormones include those responsible for menstruation.)
• With secondary amenorrhea, once pregnancy is excluded, you should receive a full medical examination by a specialist, and if you are taking any long-term medications, these should be checked out and stopped if necessary.
• Your doctor may arrange for you to have an X ray to make sure that your pituitary gland is healthy.
• If you are not ovulating, and not pregnant, he may suggest that you take a course of fertility drugs or pituitary hormones.

What Can I Do?

• The lack of periods is not dangerous and in most cases there is no cause for alarm; be patient and they will start up naturally.
• You may need to change your lifestyle to correct any dietary or physical problems, if these are the cause.

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