Absence of menstruation

Amenorrhoea (absence of menstruation) is defined as primary if periods have not occurred by the age of 16 years. It is secondary if no periods have been observed for more than 6 months.

They may be multiple.

Primary amenorrhoea is principally due to genetic causes (such as chromosomal abnormalities) or hormone imbalance. The latter can be induced by episodes of stress, weight loss (anorexia) or even by excessive physical exercise. In rarer cases, the absence of menstruation may be due to malformations, such as no uterus or the presence of a vaginal septum.

The principal causes of secondary amenorrhoea are:

• polycystic ovary syndrome
• premature ovarian insufficiency and early menopause
• hormonal imbalance involving the hypothalamus and pituitary (following stress, weight loss or extreme physical exercise) or linked to other hormones such as prolactin or thyroid hormones
• uterine abnormalities such as the presence of adhesions
• systemic diseases (diseases which affect various organs and cause diffuse pain in various parts of the body).

It is essential to diagnose the underlying disease causing the absence of periods. Your doctors will record a family history (information you provide about the history of your disease), undertake a physical gynaecological examination, measure the concentrations of hormones in your blood and perhaps undertake scans (e.g. magnetic resonance imaging).

The aim is to correct the underlying disease. You may thus receive hormone replacement therapy, which is aimed at preventing complications such as osteoporosis or cardiovascular diseases and, if you want to have a child, facilitate pregnancy.