Some Causes and Features of Amenorrhea
Cause* | Common Features† | Tests |
|---|---|---|
Hormonal disorders | ||
Hyperthyroidism (an overactive thyroid gland) | Warm, moist skin, difficulty tolerating heat, excessive sweating, an increased appetite, weight loss, bulging eyes, double vision, shakiness (tremor), and frequent bowel movements Sometimes an enlarged thyroid gland (goiter) | Blood tests to measure thyroid hormone levels |
Hypothyroidism (an underactive thyroid gland) | Difficulty tolerating cold, a decreased appetite, weight gain, coarse and thick skin, loss of eyebrow hair, a puffy face, drooping eyelids, fatigue, sluggishness, slow speech, and constipation | Blood tests to measure thyroid hormone levels |
Pituitary disorders, including tumors that produce prolactin‡ and injuries | Vision problems and headaches, particularly at night Sometimes production of breast milk in women who are not breastfeeding (galactorrhea) | Blood test to measure prolactin levels MRI of the brain |
Development of masculine characteristics (such as excess body hair, a deepened voice, and increased muscle size) Irregular or no menstrual periods, acne, excess fat in the abdomen, and dark, thick skin in the underarm, on the nape of the neck, and in skinfolds | Blood tests to measure hormone levels Ultrasonography of the pelvis to look for abnormalities in the ovaries | |
Symptoms of menopause, including hot flashes, night sweats, and vaginal dryness and thinning of vagina Risk factors such as removal of the ovaries, chemotherapy, or radiation therapy directed at the pelvis (the lowest part of the abdomen) | Blood tests to measure levels of estrogen and other hormones For women under 35, examination of chromosomes in a sample of tissue (such as blood) | |
Tumors that produce male hormones (androgens), usually in the ovaries or adrenal glands | Development of masculine characteristics, acne, and genitals that are not clearly male or female (ambiguous genitals) | CT, MRI, or ultrasonography |
Structural disorders | ||
Birth defects:
| Primary amenorrhea Normal development of breasts and secondary sexual characteristics Abdominal pain that occurs in cycles and bulging of the vagina or uterus (because menstrual blood is blocked and accumulates) | A doctor's examination Hysterosalpingography (x-rays taken after a contrast agent is injected into the uterus and fallopian tubes) or hysteroscopy (insertion of a viewing tube through the vagina to view the uterus) |
Asherman syndrome (scarring of the lining of the uterus due to an infection or surgery) | Secondary amenorrhea Often repeated miscarriages and infertility | Sonohysterography (ultrasonography after fluid is infused into uterus), hysterosalpingography, or hysteroscopy Sometimes if results are unclear, MRI |
Secondary amenorrhea Pain, vaginal bleeding, constipation, repeated miscarriages, and an urge to urinate frequently or urgently | Ultrasonography Sometimes MRI if fibroids are difficult to view or look abnormal | |
Secondary amenorrhea Vaginal bleeding | Ultrasonography, sonohysterography, or hysteroscopy | |
Conditions that cause the hypothalamus to malfunction | ||
Chronic disorders, particularly disorders of the lungs, digestive tract, blood, kidneys, or liver | Symptoms related to the specific disorder | A doctor's examination Usually various tests specific to the type of disorder |
Excessive exercise | Often a low body weight and body fat | A doctor's examination |
Infections, such as HIV infection, encephalitis, syphilis, and tuberculosis | Symptoms related to the specific disorder | A doctor's examination Usually examination, culture, and other tests of a tissue sample to identify the microorganism |
Mental disorders (such as depression or obsessive-compulsive disorder) | Withdrawal from usual activities Sluggishness or sadness Sometimes weight gain or weight loss and difficulty sleeping or too much sleep | A doctor's examination |
Poor nutrition (as may result from poverty, eating disorders, or excessive dieting) | Often low body weight and body fat or a significant loss of weight over a short time | A doctor's examination |
Stress | A stressful life event, difficulty concentrating, worry, and sleep problems (too much or too little) | A doctor's examination |
* Some medications can also cause amenorrhea.. | ||
† Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present. | ||
‡ High levels of prolactin (a hormone that stimulates the breasts to produce milk) can result in no periods. | ||
CT = computed tomography; MRI = magnetic resonance imaging. | ||