8 Causes of Amenorrhea Among Young Women

Amenorrhea refers to the lack of menstruation or period during a woman’s active reproductive years. In most cases, it is temporary and due to sudden life events, stress, or physical exertion. However, amenorrhea can also be traced back to medical issues, such as underlying genetic disorders, medication side effects, gynecological problems, and, of course, pregnancy–the most notable of amenorrhea causes. 

Learn more about these triggers and how they could impact your overall health and wellness. 

Primary Vs. Secondary Amenorrhea 

Amenorrhea is categorized into primary and secondary. Primary amenorrhea is when menstruation doesn’t kick in during puberty. In this case, a girl older than 15 years old does not experience her first period (menarche) completely. Secondary amenorrhea, on the other hand, refers to the sudden absence of menstruation for three months or more in a woman who regularly menstruates. 

Although both primary and secondary amenorrhea are characterized by the lack of period, the driving factors for each greatly vary.  

Causes of Primary Amenorrhea

Given that primary amenorrhea impacts pre-teens and teenage girls, the causes for the absence of menstruation are typically genetic or medical conditions that require proper diagnosis and treatment. It’s likely to experience this condition despite the presence of secondary sexual characteristics–meaning you continue to grow normally despite not having your period. The primary amenorrhea causes include the following: 

1. Genetic disorders

A defective gene directly involved in the production of critical hormones can cause amenorrhea. For example, a woman who has Turner syndrome or congenital ovarian hypoplasia syndrome has a missing X chromosome–either partially or completely. 

The X chromosome determines the sex of the person, along with the Y chromosome. Specifically, it establishes the attributes associated with the female reproductive system. Naturally, missing an X chromosome directly impacts your menstrual activity, specifically estrogen deficiency. 

2. Problems with the reproductive organs (rare)

A rare disorder called Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is characterized by the absence or underdevelopment of the vagina and uterus. It is the second most common cause of primary amenorrhea.

Another rare disorder that warrants primary amenorrhea is true hermaphroditism, wherein an individual has both testicular and ovarian tissues. A case report in 2012 involving a young adult diagnosed with primary amenorrhea and virilization was found to have true hermaphroditism. The complexity of the ovotestis naturally interferes with the production of the reproductive hormones, causing both conditions. 

Causes of Secondary Amenorrhea 

In secondary amenorrhea, the common causes typically involve problems developed over time or due to external factors. Addressing their amenorrhea reasons typically fixes the lack of period–making the issue temporary as opposed to primary amenorrhea, wherein the condition is lifelong. 

1. Pregnancy

The first thing that commonly crosses a woman’s mind when she misses her period is pregnancy. After all, late or absent menstruation, especially beyond three months, is a hallmark of carrying a baby. 

If you are sexually active and have missed your period two weeks after the expected schedule, taking a qualitative pregnancy test is the best thing to do. Over-the-counter pregnancy test kits measure human chorionic gonadotropin (hCG), which is a biomarker for a developing fetus.

2. Hypothalamus dysfunction (hypothalamic amenorrhea)

The hypothalamus is a part of the brain that maintains balance in the body by regulating hormones and controlling activities heart rate, sex drive, mood and temperature regulation, as well as sleep. Its relationship with menstruation stems from its role in producing the hormone called gonadotropin-releasing hormone or GnRH. 

GnRH hormone is responsible for releasing reproductive hormones like estrogen, follicle-stimulating hormone (FSH), and luteinizing hormone, which are directly involved in ovulation. Failure to produce GnRH significantly impacts the stimulation of these hormones and, thus, leads to amenorrhea. 

Problems with the hypothalamus can be triggered by stress, sudden engagement in strenuous activities, drastic weight changes, and other health conditions. When these are addressed, you will have a higher chance of correcting amenorrhea. 

3. Polycystic ovary syndrome (PCOS)

Aside from hypothalamic amenorrhea, PCOS is the other most common cause of absent period. 

Polycystic ovary syndrome, or PCOS, affects between five to six million females in the US. It’s a common hormonal problem characterized by complete or irregular anovulation (absence of ovulation). This can be triggered by the formation of multiple small cysts in the ovaries or high levels of hormones like testosterone. 

Amenorrhea in PCOS contributes greatly to fertility issues. Women diagnosed with PCOS often receive corrective treatment for the hormonal imbalance. They also follow several lifestyle adjustments that supplement the prescribed medications.  

4. Hormonal imbalance

Aside from the dysfunction in the ovaries and hypothalamus, hormonal problems can be due to issues with organs like the thyroid gland and pituitary gland in the brain. For example, the overactivity or underactivity of the thyroid gland can disrupt the secretion of the thyroid hormones T3 and T4. These hormones influence the production of the female reproductive hormones estrogen and progesterone. 

On the other hand, the thyroid-stimulating hormone (TSH) produced by the anterior pituitary gland prompts the release of the thyroid hormones. Problems with TSH escalate to hormonal imbalance. 

5. Birth control 

Birth control pills and other contraceptives can interrupt ovulation and menstruation. Even after halting your birth control, it typically takes a few months before your menstrual cycle goes back to normal. This is because the production of reproductive hormones does not jump-start quickly. 

If you’re concerned about missing your period for a long time, consult your gynecologist regarding your birth control. 

6. Certain medications and medical treatment

If you have amenorrhea and are taking some medications, make sure to determine if these drugs have an impact. Antidepressants, some allergy medications, antipsychotics, and blood pressure drugs can cause anovulation, leading to a missed period. 

In addition, chemotherapy drugs can damage egg cells and estrogen-producing tissues in the ovaries. As a result, the patient may experience temporary amenorrhea. 

Frequently Asked Questions: Amenorrhea Causes

Why am I missing my period but not pregnant?

Various factors and conditions can cause missing periods despite the lack of pregnancy. These include stress and sudden changes in your physical activity as well as metabolism that trigger hormone fluctuation. In these cases, missing your period is simply temporary–usually within one to two months. 

On the other hand, other amenorrhea reasons can induce a more prolonged absence of menstruation. These often include underlying medical conditions.    

How do you fix amenorrhea?

When treating amenorrhea, your gynecologist will identify the cause or contributing factors to the condition. For example, suppose the lack of period is due to poor weight management. In that case, you will be advised to adopt an appropriate diet, engage in physical activities, or undergo further testing to correct the metabolic issue. Meanwhile, if the problem stems from drastic hormonal fluctuations, your doctor will prescribe a proper treatment tailored to your condition and overall health status. 

Does coffee induce menstruation?

There is no clear or sufficient evidence that coffee can influence menstruation, whether it stimulates menstrual occurrence or otherwise. In fact, studies involving the relationship between coffee and reproductive hormones have mixed results. Therefore, increasing your coffee consumption to help fix amenorrhea can be futile.  

The Bottom Line

When young women experience late or missed periods, pregnancy is often assumed to be the main cause. However, it’s imperative to understand that many factors go into the occurrence of amenorrhea. If you have a regular menstrual cycle and suddenly experience a lack of menstruation for a prolonged period, make sure to consult your gynecologist to understand the possible triggers.