Amenorrhea, or the absence of a period, can occur as a consequence of several factors like intense physical exercise, stress or eating disorders. A lack of a period can also be a sign of pregnancy.

Not having a period is normally related to low estrogen levels, which can prevent ovulation and the shedding of the uterine lining during menstruation. This may lead to abnormal periods, like amenorrhea or irregular periods.

Amenorrhea that lasts for more than 3 months in a row can also be a sign of pre-menopause. It can also be noted in young girls who are just starting their period, or it can occur be the consequence of surgical removal of the uterus or ovaries.

What causes amenorrhea?

Amenorrhea can be caused by:

1. Pregnancy

Pregnancy is one of the main causes of amenorrhea, as the implantation of an embryo in the uterus causes hormonal changes that prevent a new menstrual cycle from occurring.

Check-out the other symptoms of implantation that can occur in addition to amenorrhea.

What to do: If you suspect you may be pregnant, you should take a pregnancy test. This test can be done at home using a urine sample or in a doctor's office with a blood sample, and it aims to check hCG levels in the body.

If pregnancy is confirmed, it is important to consult an OBGYN for assessment and prenatal monitoring.

2. Intense physical exercise

Intense physical activity like marathon running, competitive swimming or gymnastics can lead to high endorphin and ACTH levels in the blood. This can interfere with the levels of female hormones that regulate the menstrual cycle, and possibly lead to amenorrhea.

What to do: In this case, you should ideally reduce the intensity of training to regulate your menstrual cycle. If you think that exercise may be causing amenorrhea, it may also be a good idea to consult an endocrinologist or gynecologist so that hormonal changes can be properly monitored and the need for any treatment can be assessed.

3. Stress

Stress can also lead to a lack of menstruation, as it leads to high cortisol levels which can interfere with the menstrual cycle. Read more about high cortisol levels and the other symptoms it can cause.

What to do: To treat this condition, you are advised to incorporate lifestyle changes that can help you relax, like regular exercise, meditation, reading, yoga and social activities. Moderate to severe stress can also be managed with therapy and medication as needed.

4. Eating disorders

Eating disorders like anorexia or bulimia, or having a diet that is low in nutrients can also lead to amenorrhea. These conditions can lead to malnutrition, which interferes with hormone levels.

What to do: It is important to consult a registered dietitian to determine any struggles or weaknesses in eating patterns and to make changes to ensure you are on a nutrient-dense. This can help to regulate menstruation and restore regular periods. It is essential to also receive psychological support to treat the underlying cause of any eating disorders.

5. Thyroid problems

Abnormal thyroid functioning, which can happen with hyper or hypothyroidism, can also lead to amenoorhea. Abnormal thyroid levels can influence estrogen and progesterone levels, impacting the menstrual cycle.

Read about other symptoms of thyroid problems that you should monitor and report to your doctor.

What to do: It is important to consult a gynecologist or endocrinologist for thyroid testing and treatment as needed to regulate thyroid hormone production.

6. Use of medications

Some medications, such as corticosteroids, antidepressants, chemotherapy, antihypertensives or immunosuppressants, can lead to amenorrhea as a side effect.

What to do: If you notice a lack of a period after starting a new medication, it is important to report this to your prescriber to determine whether this medication should be suspended or if dosing should be reassessed.

7. Reproductive system disease

Reproductive system diseases, polycystic ovarian syndrome, endometriosis, fibroids or uterine tumors can lead to abnormal periods or amenorrhea, as all of these conditions are related to fluctuations in female hormones.

What to do: Amenorrhea that is secondary to a reproductive condition can be restored by adhering to treatment as indicated by your doctor. He or she may prescribe medication or advise surgery, depending on the condition that is diagnosed.

8. Brain-related conditions

Some brain-related conditions, such as malfunctioning of the pituitary gland and hypothalamus, can also cause the absence of menstruation. These flands are related to the production and activation of hormones, and abnormal functioning and lead to amenorrhea.

What to do: It is important to consult your doctor for testing to assess functioning of the pituitary gland and hypothalamus. Confirming a diagnosis can help to guide that the most appropriate treatment approach.

When to see a gynecologist

It is necessary to see a gynecologist when:

Girls over 13 do not show signs of puberty, like a lack of pubic or axillary hair growth, lack of breast growth and reduced rounding of the hips;
If menstruation does not come by the age of 16;
If, in addition to the absence of menstruation, the woman presents other symptoms such as a fast heartbeat, anxiety, sweating, weight loss;
When a woman is over 40 and has not had a period for more than 12 months and has already ruled out the possibility of pregnancy or has irregular periods.

The gynecologist who may order blood tests to assess hormone levels or an ultrasound to rule out the existence of any conditions or problems in the ovaries, thyroid or adrenal glands.