WHAT YOU NEED TO KNOW:

What is amenorrhea? Amenorrhea is the absence of menstruation (your monthly period). Primary amenorrhea means your period did not start by age 16. This is usually because of a lack of reproductive organs, such as a uterus. Breasts and other signs of puberty that usually start to develop by age 14 do not develop. Secondary amenorrhea means you stopped having regular periods for at least 3 months or irregular periods for 6 months. Amenorrhea may be a sign of a serious medical problem that needs to be treated.

What causes amenorrhea? Your period may stop while you are breastfeeding or under more stress than usual. Birth control pills may prevent your period from starting for a few months after you stop taking them. The following may also cause amenorrhea:

• Scarring in your uterus, an abnormally shaped vagina, or a narrow cervix
  
  
• Medicines such as those used to treat depression, high blood pressure, or pain
  
  
• A hormone imbalance from a condition such as PCOS, thyroid problems, or a pituitary tumor
  
  
• Premature menopause, or ovarian failure from treatments such as chemotherapy
  
  
• Low body weight or too much exercise
  
  
• Not enough calories because of an eating disorder, such as anorexia, or a low-calorie diet
  
  
• Bulimia (bingeing and purging to control weight)
  
  
• Large amount of weight gained or lost

What other signs or symptoms may I have with amenorrhea?

• Hair growth on your face or over your breastbone, or bald patches
  
  
• Acne
  
  
• Pelvic pain
  
  
• Headaches
  
  
• Vision changes
  
  
• Bruises or patches of dark skin

How is the cause of amenorrhea diagnosed and treated?

• Your healthcare provider may use blood tests, an ultrasound, or an MRI to find the cause. Do not enter the MRI room with anything metal. Metal can cause serious damage. Tell the healthcare provider if you have any metal in or on your body. Your healthcare provider may use a scope to check your uterus and cervix during a procedure called hysteroscopy.
  
  
• Treatment will depend on what is causing your amenorrhea. You may be given birth control pills to restart and regulate your periods. You may need medicines to treat medical conditions such as a thyroid or pituitary disorder, or PCOS. Surgery may fix a problem that is preventing blood from flowing through your vagina, or to remove a tumor.

What can I do to prevent or manage amenorrhea?

• Maintain a healthy weight. Low body weight, overweight, or obesity can all affect your period. Your healthcare provider can help you create a plan to reach and maintain a healthy weight.
  
  
• Eat healthy foods. Healthy foods include fruits, vegetables, whole-grain breads, low-fat dairy products, beans, lean meats, and fish. You may need to have more calcium and vitamin D if your amenorrhea is caused by low estrogen levels. Low estrogen can affect bone strength. Calcium and vitamin D work together to help build bone. Your healthcare provider or a dietitian can help you create a meal plan that has the right number of calories and nutrients for you.
  
  
• Exercise as directed. Exercise can help you build or maintain bone. Exercise can also help you lose weight if you are overweight. Ask your healthcare provider how much to exercise and which exercises are best for you. Do not exercise more than your healthcare provider recommends. Too much exercise can cause your period to stop.
  
  
• Keep a record of your monthly periods. Record the dates your period started and stopped. Also record any pain or other problems during your period.
  
  
• Manage stress. Try new ways to relax, such as deep breathing. Ask your healthcare provider for more information on stress management.

What are the risks of amenorrhea? Amenorrhea may lead to infertility (not able to have children). You may also develop osteoporosis. Osteoporosis is a serious condition that causes bones to become weak, brittle, and easily fractured.

When should I contact my healthcare provider?

• You notice changes in your menstrual cycle, such as periods that start and stop a few times.
  
  
• Your female child is 14, has not started menstruating, and is not developing signs of puberty.
  
  
• Your female child is 16 and has developed signs of puberty, but she has not started menstruating.
  
  
• You have questions or concerns about your condition or care.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.