Amenorrhea, or a complete absence of a menstrual period, is a symptom, not a disease. Many reasons may cause this symptom, and diagnosing amenorrhea is one of most difficult tasks a gynecologist can face. However, reasons are mostly simple.

In cases of women with regular or irregular periods, the absence of menstrual period for the time of six months is classified as amenorrhea. In adolescents who have never developed menstrual periods, amenorrhea is diagnosed with the absence of the first period (menarche) until the age of 14, if no secondary sex characteristics have been developed (pubic and armpit hair, breast growth), or until the age of 16, if secondary sex characteristics have been developed.

The causes of amenorrhea may be as follows:

1. disorders of uterine blood discharge, mostly connected with uterine and cervical disorders
2. ovarian conditions
3. anterior pituitary gland disorders
4. hypothalamic disorders

Process of discovering causes is a gradual one and starts with a detailed conversation with a patient. During the course of a conversation we find out about stress levels, family history of similar conditions, eating and growth disorders. This is followed by a gynecologic examination, ultrasound, induced bleeding by progestins and, when necessary, examination of hormone status.

Causes of amenorrhea may be:

1. disorders of uterine blood discharge, mostly connected with uterine and cervical conditions

– Asherman’s syndrome (AS) – adhaesions of intrauterine cavity, usually caused by curettage

– absence of some or all female sex organs (Küster Rokitansky syndrome, testicular feminisation syndrome)

2. ovarian conditions

– chromosome disorders (Turner syndrome, mosaicisms, resistant ovary syndrome) – (early) menopause – elevated FSH in blood

3. anterior pituitary gland disorders

– galactorrhea – breast milk discharge, usually caused by elevated prolactin in blood

4. hypothalamic disorders

– hypothalamic amenorrhea – disrupted hormonal production by the hypothalamus

– weight loss

– eating disorders

– anorexia, bulimia

– extensive exercising

– anovulation – absence of ovulation

– hypothyroidism (underactive thyroid gland) – identified by elevated levels of thyroid-stimulating hormone (TSH)

Since in the case of amenorrhea there is no ovulation, all of the above causes induce infertility, at least temporarily. Some are unfortunately hard or even impossible to treat.