What is amenorrhea (absence of menstruation)?
Amenorrhea is the absence of menstruation. There are two categories: primary amenorrhea and secondary amenorrhea. Such terms are used only to describe the timing of menstrual cessation; they do not indicate any cause or suggest any other information.
Primary amenorrhea occurs when a girl does not even start to menstruate. Girls who show no signs of sexual development (breast development and pubic hair) by age 14 should be evaluated. Girls who do not have their periods by two years after sexual development should also be checked. Any girl who does not have her period by age 16 should be evaluated for primary amenorrhea. Secondary amenorrhea is a condition in which periods that were previously regular become absent for at least three cycles.
Many conditions that cause amenorrhea, such as ovulation abnormalities, are major contributors to infertility. Irregular periods from any cause make it more difficult to conceive. Amenorrhea that is associated with reduced estrogen levels increases the risk for osteoporosis (loss of bone density). Because bone growth is at its peak in adolescence and young adulthood, losing bone density at that time is very dangerous, and early diagnosis and treatment is essential for long-term health. Young highly competitive female athletes or dancers and those with eating disorders are at risk for bone loss--but only if they also have amenorrhea.
Reducing stress may help resolve the disorder in some women. Being either over- or underweight is a contributor to menstrual disorders. Women should make every effort to maintain a normal weight. Exercise is very important in maintaining good health. Although unusually vigorous exercise can cause menstrual irregularity and even amenorrhea, few women exercise to the extent that their periods are affected. For those who do, a recent study found that simply adding calories can restore regular menstruation in such women. Competitive athletes do not have to stop exercising to restore fertility. They simply need to eat more.
Some women may resort to herbal or so-called natural remedies. Although many are now being produced by recognized manufacturers, none require US government regulations and no one should take any remedies for medical conditions without consulting a physician.