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Health Condition

Amenorrhea

About This Condition

Amenorrhea is the absence of menstrual cycles.

Amenorrhea is called primary when a woman has not started to menstruate by the age of 16 years, while secondary amenorrhea refers to the abnormal cessation of menstruation in a woman who previously has had menstrual cycles.1 In amenorrheic women, the levels of female reproductive hormones are not sufficient to stimulate menstruation. This condition is sometimes associated with malnutrition, such as that which occurs in anorexia nervosa, or with extreme exercise, which puts excessive nutritional and other demands on the body.2,3 An association between stress and amenorrhea has also been demonstrated.4 Amenorrhea may also result from potentially serious disorders of the ovaries, the hypothalamus, or the pituitary gland; therefore, a physician should always evaluate chronic absence of menstrual cycles. Prolonged amenorrhea can result in early bone loss and increased risk of osteoporosis.5 Amenorrhea occurs naturally in women who are breast-feeding,6 but in these circumstances it does not put the bones at risk.7

Symptoms

Women with amenorrhea may have symptoms of absent periods, increased facial hair, decreased pubic and armpit hair, deeper voice, decreased breast size, and secretions from the breast.

References

1. Fagan KM. Pharmacologic management of athletic amenorrhea. Clin Sports Med 1998;17:327-41 [review].

2. Yen SS. Effects of lifestyle and body composition on the ovary. Endocrinol Metab Clin North Am 1998;27:915-26,ix [review].

3. Sanborn CF, Horea M, Siemers BJ, Dieringer KI. Disordered eating and the female athlete triad. Clin Sports Med 2000;19:199-213 [review].

4. Berga SL, Loucks-Daniels TL, Adler LJ, et al. Cerebrospinal fluid levels of corticotropin-releasing hormone in women with functional hypothalamic amenorrhea. Am J Obstet Gynecol 2000;182:776-81.

5. Carmichael KA, Carmichael DH. Bone metabolism and osteopenia in eating disorders. Medicine (Baltimore) 1995;74:254-67 [review].

6. McNeilly AS, Tay CC, Glasier A. Physiological mechanisms underlying lactational amenorrhea. Ann N Y Acad Sci 1994;709:145-55 [review].

7. Kalkwarf HJ. Hormonal and dietary regulation of changes in bone density during lactation and after weaning in women. J Mammary Gland Biol Neoplasia 1999;4:319-29 [review].

8. Shangold MM, Tomai TP, Cook JD, et al. Factors associated with withdrawal bleeding after administration of oral micronized progesterone in women with secondary amenorrhea. Fertil Steril 1991;56:1040-7.

9. Genazzani AD, Petraglia F, Algeri I, et al. Acetyl-l-carnitine as possible drug in the treatment of hypothalamic amenorrhea. Acta Obstet Gynecol Scand 1991;70:487-92.

10. McIntosh EN. Treatment of women with the galactorrhea-amenorrhea syndrome with pyridoxine (vitamin B6). J Clin Endocrinol Metab 1976;42:1192-5.

11. Kidd GS, Dimond R, Kark JA, et al. The effects of pyridoxine on pituitary hormone secretion in amenorrhea-galactorrhea syndromes. J Clin Endocrinol Metab 1982;54:872-5.

12. Spiegel AM, Rosen SW, Weintraub BD, Marynick SP. Effect of intravenous pyridoxine on plasma prolactin in hyperprolactinemic subjects. J Clin Endocrinol Metab 1978;46:686-8.

13. Lehtovirta P, Ranta T, Seppala M. Pyridoxine treatment of galactorrhoea-amenorrhoea syndromes. Acta Endocrinol (Copenh) 1978;87:682-6.

14. Tolis G, Laliberte R, Guyda H, Naftolin F. Ineffectiveness of pyridoxine (B6) to alter secretion of growth hormone and prolactin and absence of therapeutic effects on galactorrhea-amenorrhea syndromes. J Clin Endocrinol Metab 1977;44:1197-9.

15. Goodenow TJ, Malarkey WB. Ineffectiveness of pyridoxine in evaluation and treatment of the hyperprolactinemic amenorrhea-galactorrhea syndrome. Am J Obstet Gynecol 1979;133:161-4.

16. Igarashi M. Augmentative effect of ascorbic acid upon induction of human ovulation in clomiphene-ineffective anovulatory women. Int J Fertil 1977;22:168-73.

17. Veal L. Complementary therapy and infertility: an Icelandic perspective. Complement Ther Nurs Midwifery 1998;4:3-6 [review].

18. Sliutz G, Speiser P, Schultz AM, et al. Agnus castus extracts inhibit prolactin secretion of rat pituitary cells. Horm Metab Res 1993;25:253-5.

19. Milewicz A, Gejdel E, Sworen H, et al. Vitex agnus castus extract in the treatment of luteal phase defects due to latent hyperprolactinemia. Results of a randomized placebo-controlled double-blind study. Arzneimittelforschung 1993;43:752-6 [in German].

20. Brown DJ. Herbal Prescriptions for Health and Healing. Roseville, CA: Prima Health, 2000, 235-8.

21. Loch EG, Katzorke T. Diagnosis and treatment of dyshormonal menstrual periods in general practice. Gynäkol Praxis 1990;14:489-95.

22. Stener-Victorin E, Waldenstrom U, Tagnfors U, et al. Effects of electro-acupuncture on anovulation in women with polycystic ovary syndrome. Acta Obstet Gynecol Scand 2000;79:180-8.

23. Mo X, Li D, Pu Y, et al. Clinical studies on the mechanism for acupuncture stimulation of ovulation. J Tradit Chin Med 1993;13:115-9.

24. Yu J, Zheng HM, Ping SM. Changes in serum FSH, LH and ovarian follicular growth during electroacupuncture for induction of ovulation. Chung Hsi I Chieh Ho Tsa Chih 1989;9:199-202,195 [in Chinese].

25. Gerhard I, Postneek F. Possibilities of therapy by ear acupuncture in female sterility. Geburtshilfe Frauenheilkd 1988;48:165-71 [in German].

26. Kubista E, Boschitsch E, Spona J. Effect of ear-acupuncture on the LH-concentration in serum in patients with secondary amenorrhea. Wien Med Wochenschr 1981;131:123-6 [in German].

27. Koebnick C, Strassner C, Hoffmann I, Leitzmann C. Consequences of a long-term raw food diet on body weight and menstruation: results of a questionnaire survey. Ann Nutr Metab 1999;43:69-79.

28. Barr SI. Vegetarianism and menstrual cycle disturbances: is there an association? Am J Clin Nutr 1999;70:549S-54S [review].

29. Kemmann E, Pasquale SA, Skaf R. Amenorrhea associated with carotenemia. JAMA 1983;249:926-9.

30. Frumar AM, Meldrum DR, Judd HL. Hypercarotenemia in hypothalamic amenorrhea. Fertil Steril 1979;32:261-4.

31. Martin-Du Pan RC, Hermann W, Chardon F. Hypercarotenemia, amenorrhea and a vegetarian diet. J Gynecol Obstet Biol Reprod (Paris) 1990;19(3):290-4 [in French].

32. Cassidy A, Bingham S, Setchell K. Biological effects of isoflavones in young women: importance of the chemical composition of soyabean products. Br J Nutr 1995;74:587-601.

33. Cassidy A, Bingham S, Setchell KD. Biological effects of a diet of soy protein rich in isoflavones on the menstrual cycle of premenopausal women. Am J Clin Nutr 1994;60:333-40.

34. Lu LJ, Anderson KE, Grady JJ, et al. Decreased ovarian hormones during a soya diet: implications for breast cancer prevention. Cancer Res 2000;60:4112-21.

35. Wu AH, Stanczyk FZ, Hendrich S, et al. Effects of soy foods on ovarian function in premenopausal women. Br J Cancer 2000;82:1879-86.

36. Xu X, Duncan AM, Merz BE, Kurzer MS. Effects of soy isoflavones on estrogen and phytoestrogen metabolism in premenopausal women. Cancer Epidemiol Biomarkers Prev 1998;7:1101-8.

37. Lu LJ, Anderson KE, Grady JJ, Nagamani M. Effects of soya consumption for one month on steroid hormones in premenopausal women: implications for breast cancer risk reduction. Cancer Epidemiol Biomarkers Prev 1996;5:63-70.

38. Martini MC, Dancisak BB, Haggans CJ, et al. Effects of soy intake on sex hormone metabolism in premenopausal women. Nutr Cancer 1999;34:133-9.

39. Duncan AM, Merz BE, Xu X, et al. Soy isoflavones exert modest hormonal effects in premenopausal women. J Clin Endocrinol Metab 1999;84:192-7.

40. Miller KK, Parulekar MS, Schoenfeld E, et al. Decreased leptin levels in normal weight women with hypothalamic amenorrhea: the effects of body composition and nutritional intake. J Clin Endocrinol Metab 1998;83:2309-12.

41. Snow RC, Schneider JL, Barbieri RL. High dietary fiber and low saturated fat intake among oligomenorrheic undergraduates. Fertil Steril 1990;54:632-7.

42. Warren MP, Holderness CC, Lesobre V, et al. Hypothalamic amenorrhea and hidden nutritional insults. J Soc Gynecol Investig 1994;1:84-8.

43. Couzinet B, Young J, Brailly S, et al. Functional hypothalamic amenorrhoea: a partial and reversible gonadotrophin deficiency of nutritional origin. Clin Endocrinol (Oxf) 1999;50:229-35.

44. Laughlin GA, Dominguez CE, Yen SS. Nutritional and endocrine-metabolic aberrations in women with functional hypothalamic amenorrhea. J Clin Endocrinol Metab 1998;83:25-32.

45. Koebnick C, Strassner C, Hoffmann I, Leitzmann C. Consequences of a long-term raw food diet on body weight and menstruation: results of a questionnaire survey. Ann Nutr Metab 1999;43:69-79.

46. Barr SI. Vegetarianism and menstrual cycle disturbances: is there an association? Am J Clin Nutr 1999;70:549S-54S [review].

47. Kemmann E, Pasquale SA, Skaf R. Amenorrhea associated with carotenemia. JAMA 1983;249:926-9.

48. Frumar AM, Meldrum DR, Judd HL. Hypercarotenemia in hypothalamic amenorrhea. Fertil Steril 1979;32:261-4.

49. Martin-Du Pan RC, Hermann W, Chardon F. Hypercarotenemia, amenorrhea and a vegetarian diet. J Gynecol Obstet Biol Reprod (Paris) 1990;19(3):290-4 [in French].

50. Cassidy A, Bingham S, Setchell K. Biological effects of isoflavones in young women: importance of the chemical composition of soyabean products. Br J Nutr 1995;74:587-601.

51. Cassidy A, Bingham S, Setchell KD. Biological effects of a diet of soy protein rich in isoflavones on the menstrual cycle of premenopausal women. Am J Clin Nutr 1994;60:333-40.

52. Lu LJ, Anderson KE, Grady JJ, et al. Decreased ovarian hormones during a soya diet: implications for breast cancer prevention. Cancer Res 2000;60:4112-21.

53. Wu AH, Stanczyk FZ, Hendrich S, et al. Effects of soy foods on ovarian function in premenopausal women. Br J Cancer 2000;82:1879-86.

54. Xu X, Duncan AM, Merz BE, Kurzer MS. Effects of soy isoflavones on estrogen and phytoestrogen metabolism in premenopausal women. Cancer Epidemiol Biomarkers Prev 1998;7:1101-8.

55. Lu LJ, Anderson KE, Grady JJ, Nagamani M. Effects of soya consumption for one month on steroid hormones in premenopausal women: implications for breast cancer risk reduction. Cancer Epidemiol Biomarkers Prev 1996;5:63-70.

56. Martini MC, Dancisak BB, Haggans CJ, et al. Effects of soy intake on sex hormone metabolism in premenopausal women. Nutr Cancer 1999;34:133-9.

57. Duncan AM, Merz BE, Xu X, et al. Soy isoflavones exert modest hormonal effects in premenopausal women. J Clin Endocrinol Metab 1999;84:192-7.

58. Bringer J, Lefebvre P, Renard E. Nutritional hypogonadism. Rev Prat 1999;49:1291-6 [review, in French].

59. Yen SS. Effects of lifestyle and body composition on the ovary. Endocrinol Metab Clin North Am 1998;27:915-26,ix [review].

60. Dueck CA, Matt KS, Manore MM, Skinner JS. Treatment of athletic amenorrhea with a diet and training intervention program. Int J Sport Nutr 1996;6:24-40.

61. Kopp-Woodroffe SA, Manore MM, Dueck CA, et al. Energy and nutrient status of amenorrheic athletes participating in a diet and exercise training intervention program. Int J Sport Nutr 1999;9:70-88.

62. Warren MP, Stiehl AL. Exercise and female adolescents: effects on the reproductive and skeletal systems. J Am Med Womens Assoc 1999;54:115-20, 138 [review].

63. Jonnavithula S, Warren MP, Fox RP, Lazaro MI. Bone density is compromised in amenorrheic women despite return of menses: a 2-year study. Obstet Gynecol 1993;81:669-74.

64. Sanborn CF, Horea M, Siemers BJ, Dieringer KI. Disordered eating and the female athlete triad. Clin Sports Med 2000;19:199-213 [review].

65. Manore MM. Nutritional needs of the female athlete. Clin Sports Med 1999;18:549-63 [review].

66. Benson JE, Engelbert-Fenton KA, Eisenman PA. Nutritional aspects of amenorrhea in the female athlete triad. Int J Sport Nutr 1996;6:134-45 [review].

67. Frederick L, Hawkins ST. A comparison of nutrition knowledge and attitudes, dietary practices, and bone densities of postmenopausal women, female college athletes, and nonathletic college women. J Am Diet Assoc 1992;92:299-305.

68. Hirschberg AL, Hagenfeldt K. Athletic amenorrhea and its consequences. Hard physical training at an early age can cause serious bone damage. Lakartidningen 1998;95:5765-70 [review, in Swedish].

69. Kleiner SM, Bazzarre TL, Ainsworth BE. Nutritional status of nationally ranked elite bodybuilders. Int J Sport Nutr 1994;4:54-69.

70. Dueck CA, Matt KS, Manore MM, Skinner JS. Treatment of athletic amenorrhea with a diet and training intervention program. Int J Sport Nutr 1996;6:24-40.

71. Kopp-Woodroffe SA, Manore MM, Dueck CA, et al. Energy and nutrient status of amenorrheic athletes participating in a diet and exercise training intervention program. Int J Sport Nutr 1999;9:70-88.

72. McNeilly AS, Tay CC, Glasier A. Physiological mechanisms underlying lactational amenorrhea. Ann N Y Acad Sci 1994;709:145-55 [review].

73. Peng YK, Hight-Laukaran V, Peterson AE, Perez-Escamilla R. Maternal nutritional status is inversely associated with lactational amenorrhea in Sub-Saharan Africa: results from demographic and health surveys II and III. J Nutr 1998;128:1672-80.

74. Delgado HL, Martorell R, Klein RE. Nutrition, lactation, and birth interval components in rural Guatemala. Am J Clin Nutr 1982;35:1468-76.

75. Lunn PG, Austin S, Prentice AM, Whitehead RG. The effect of improved nutrition on plasma prolactin concentrations and postpartum infertility in lactating Gambian women. Am J Clin Nutr 1984;39:227-35.

76. Tracer DP. Lactation, nutrition, and postpartum amenorrhea in lowland Papua New Guinea. Hum Biol 1996;68:277-92.

77. Prema K, Naidu AN, Neelakumari S, Ramalakshmi BA. Nutrition—fertility interaction in lactating women of low income groups. Br J Nutr 1981;45:461-7.

78. Heinig MJ, Nommsen-Rivers LA, Peerson JM, Dewey KG. Factors related to duration of postpartum amenorrhoea among USA women with prolonged lactation. J Biosoc Sci 1994;26:517-27.

79. Lunn PG, Prentice AM, Austin S, Whitehead RG. Influence of maternal diet on plasma-prolactin levels during lactation. Lancet 1980 Mar 22;1(8169):623-5 [review].

80. Tennekoon KH, Karunanayake EH, Seneviratne HR. Effect of skim milk supplementation of the maternal diet on lactational amenorrhea, maternal prolactin, and lactational behavior. Am J Clin Nutr 1996;64:283-90.

81. Kalkwarf HJ. Hormonal and dietary regulation of changes in bone density during lactation and after weaning in women. J Mammary Gland Biol Neoplasia 1999;4:319-29 [review].

82. Berga SL, Loucks-Daniels TL, Adler LJ, et al. Cerebrospinal fluid levels of corticotropin-releasing hormone in women with functional hypothalamic amenorrhea. Am J Obstet Gynecol 2000;182:776-81.

83. Gallinelli A, Matteo ML, Volpe A, Facchinetti F. Autonomic and neuroendocrine responses to stress in patients with functional hypothalamic secondary amenorrhea. Fertil Steril 2000;73:812-6.

84. Meczekalski B, Tonetti A, Monteleone P, et al. Hypothalamic amenorrhea with normal body weight: ACTH, allopregnanolone and cortisol responses to corticotropin-releasing hormone test. Eur J Endocrinol 2000;142:280-5.

85. Johnson J, Whitaker AH. Adolescent smoking, weight changes, and binge-purge behavior: associations with secondary amenorrhea. Am J Public Health 1992;82:47-54.

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The information presented by Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires December 2018.

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