Why Does Secondary Amenorrhea Happen, and Is There Treatment?
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Medically reviewed by Monique Rainford, MD
Secondary amenorrhea is when people who already menstruate don't get their period for three months in a row or longer. Pregnancy is the most common explanation for secondary amenorrhea, but certain medical conditions or medications can also be causes.
Secondary amenorrhea can be temporary, come and go, or be permanent. Identifying the cause or underlying condition can help healthcare providers determine effective treatment options.
This article discusses the possible causes of secondary amenorrhea, the symptoms that accompany the condition, the complications involved, and treatment options.
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How Do You Pronounce Amenorrhea?
Amenorrhea is pronounced uh-men-o-REE-uh.
Primary vs. Secondary Amenorrhea
Primary amenorrhea is the failure to have a menstrual period by age 15. It affects individuals who have never had a period. On the other hand, secondary amenorrhea occurs in those who have already started having menstrual cycles and miss three or more in a row.
Primary amenorrhea is often caused by genetic abnormalities, delayed puberty, problems with reproductive development, or issues with the hypothalamus or pituitary gland in the brain.
Generally, secondary amenorrhea is much more common than primary amenorrhea. Secondary amenorrhea that is not due to natural causes like pregnancy affects about 3% to 4% of women.
Sex/Gender Terminology
In this article, the term women is used to describe individuals who were assigned female sex at birth.
What Causes Secondary Amenorrhea?
Some possible causes of secondary amenorrhea include:
Pregnancy, breastfeeding, or menopause
Low body weight or rapid weight loss
Excessive exercise
An eating disorder, such as anorexia nervosa
Obesity
Polycystic ovary syndrome (PCOS): When there is an imbalance of the reproductive hormones
Thyroid issues
A pituitary gland tumor
Stress
Primary ovarian insufficiency: When the ovaries stop working normally before age 40
Other chronic medical problems, such as inflammatory bowel disease (IBD) or kidney failure
Scar tissue caused by a dilation and curettage (D and C) procedure
Certain medications, such as birth control, chemotherapy, blood pressure meds, or treatments for mental health disorders
Complications: How Serious Is Secondary Amenorrhea?
A person should be evaluated for amenorrhea if their period stops for more than three months without an explanation.
Secondary amenorrhea can be a sign of an underlying medical issue that can lead to further problems if untreated. Other possible complications are osteoporosis (loss of bone mass and density) or cardiovascular (heart) disease if estrogen levels are very low. Additionally, you may be at risk for infertility or pregnancy problems if you're not ovulating as you should.
Is Secondary Amenorrhea Considered Serious?
Your outlook will depend on what's prompting your missed periods. Often, conditions that cause secondary amenorrhea respond well to treatment.
Symptoms of Secondary Amenorrhea (Besides No Period)
In addition to missed periods, symptoms of secondary amenorrhea may include:
Changes in breast size
Weight gain or weight loss
Increased hair growth
Deepening of the voice
Headaches
Explaining Secondary Amenorrhea Symptoms
Symptoms of secondary amenorrhea are often triggered by the underlying condition that's causing missed periods.
Treatment Options for Secondary Amenorrhea
Treatment for secondary amenorrhea will depend on the cause. Some hormonal therapies can help bring on a regular menstrual cycle. Some treatment options may include:
Primary ovarian insufficiency: If this is the cause for missed periods, healthcare providers may recommend hormone therapy.
PCOS: It's often treated with oral birth control (the pill). For people with PCOS who want to become pregnant, medications such as clomiphene citrate may be given to help promote ovulation.
Hypothyroidism: Hormone treatments may be recommended.
Pituitary tumor: Healthcare providers may recommend removing the tumor.
They may also want to remove scar tissue, cysts, or uterine adhesions that can affect a person's periods. People who experience missed periods due to weight loss, obesity, or an eating disorder may be referred to a specialist for treatment.
Pregnancy During Secondary Amenorrhea
You can still get pregnant, even if you miss your period due to a condition that causes secondary amenorrhea.
Holistic Options to Help Secondary Amenorrhea
Some people with secondary amenorrhea may benefit from lifestyle changes like a healthy diet, exercise, and stress-reducing activities.
Experts recommend consuming the following daily:
600 international units (IU) of vitamin D
1,000–13,000 milligrams (mg) of calcium
Though there’s no hard evidence to prove their effectiveness, some people take herbal remedies, such as blue cohosh, black cohosh, asafetida, alfalfa seed, angelica, motherwort, parsley, ginger, and rue to regulate their menstrual cycles.
Always talk to a healthcare provider before taking an herbal supplement, especially if you take other medications.
Summary
Secondary amenorrhea is a condition that happens when a person who menstruates doesn’t get their period for three months in a row or longer. If you're not pregnant, a variety of medical issues can be triggering missed periods. Treatments for secondary amenorrhea will depend on the cause. Many underlying problems are treatable. Talk to a healthcare provider if you’ve missed your period for three months or longer.
