Causes of No Menses (Absent Menstruation)

What is absent menstruation?

Absent menstruation (no menses) is the absence of menstrual periods. It is also known as amenorrhea.

Women who have missed 3 to 6 consecutive menstrual periods have no menses. Similarly, girls who have not started menstruating by age 16 do have amenorrhea.

Types of absent menstruation

The type of menstruation depends on whether menstruation has occurred and then stopped or whether menstruation has not started by age 16. Two types of absent menstruation exist. They include: primary and secondary amenorrhea.

Primary Amenorrhea

Primary amenorrhea is the absence of menstrual periods in a teenage girl who has reached or passed the age of 16.

Therefore, a teenage girl who hasn’t had her first period at age 16 is said to have primary amenorrhea. Keep in mind that most girls start menstruating between the ages of 9 and 18 years. However the average is 12 years.

Secondary amenorrhea

This is when a woman’s monthly menstrual periods stopped for at least three months. Secondary amenorrhea is the more common form of amenorrhea. In most cases, both primary and secondary amenorrhea can be treated effectively.

What are the causes of no menses?

Primary and secondary amenorrhea occur for various reasons. Some of the causes of absent menstruation are natural while others are medical conditions which can be treated.

Here are the common causes of absent menstruation:

Natural causes

The natural causes of amenorrhea include: pregnancy, breastfeeding and menopause.

Lifestyle factors

Gaining too much body fat or having too little body fat may stop or delay menstruation. Also, stress and excessive exercise may cause amenorrhea.

Hormonal imbalances

Evidence shows that hormonal imbalances can cause absent menstruation. Hormonal imbalances can be caused by tumors on the thyroid gland or pituitary gland.

Also, high testosterone levels or low estrogen levels cause amenorrhea.

Genetic disorders or chromosomal disorders

Chromosomal disorders such as Sawyer syndrome and Turner syndrome can sometimes cause late menstruation.

Physical defects

Physical defects in the female reproductive organs may cause delayed or absent menstruation.

Structural problems in the female reproductive organs may result from tumors, infections occurring in the womb or shortly after birth, or birth defects.

Asherman’s syndrome

In rare cases, missed periods may also from Asherman’s syndrome. Asherman’s syndrome occurs due to scarring in the uterus after surgery. This can prevent menstruation.

Medications

In some women, medications can cause absent menstruation. Examples of medications causing amenorrhea include antidepressants and antipsychotics.

Also, stopping birth control pills suddenly can cause several months of absent menstruation before the menstrual cycle returns to normal.

Medications that treat high blood pressure and chemotherapy drugs can cause problems with menstrual periods.

When to see a doctor

A teenage girl who is yet to start menstruating at the age of 16 should see a doctor. Similarly, a teenage girl may need to see a doctor if she hasn’t had any signs of puberty at age 14.

These signs of puberty would have occurred normally by the time a teenage girl has reached 14 years of age:

• Breast bud development (thelarche)
• Pubic hair development (pubarche)
• Onset of menstrual periods (menarche)

So, the bottom line is that menstruating teens and women who missed three or more consecutive periods should see a doctor.

How is amenorrhea diagnosed?

Having gone to see a doctor, s/he will ask you some questions and perform a physical examination. It is important you talk to him/her about your symptoms, menstrual cycle and lifestyle.

Your doctor will ask you to do a pregnancy test if you have missed three menstrual periods in a row. If pregnancy is ruled out, your doctor may order more tests to ascertain the underlying cause(s) of your amenorrhea.

The other tests your doctor may ask you to do include:

Blood tests

Blood tests will enable your doctor to determine your hormone levels. For example, luteinizing hormone, follicle stimulating hormones and prolactin are all linked to menstruation.

So, determining the levels of these hormones will help your doctor rule out or confirm the possible cause of your absent menstruation.

CT scan

CT scan is an imaging test that uses rotating X-ray machines and computers to produce cross-sectional images of the body.

Images produced by CT scan enable your doctor to view possible tumors or masses in your organs or glands.

Ultrasound

Ultrasound scan is an imaging test that makes use of high frequency sound waves to produce clear pictures of the body parts.

With an ultrasound scan, your doctor will be able to view the body organs such as the uterus and ovaries. It is also used to check for abnormal growths.

What is the treatment for absent menstruation?

Your doctor will be able to treat your absent menstruation. However, treatment varies depending on the underlying cause.

For hormonal imbalances, your doctor may recommend synthetic or supplemental hormones to help normalize hormone levels.

Also, if your absent menstruation is due to uterine lesions, ovarian cysts or scar tissue, your doctor may consider surgical removal.

Your doctor may recommend that you change your lifestyle. For example, changes may be required if exercise or weight is exacerbating your condition. If necessary, your doctor may refer you to a dietician or a nutritionist.

Nutritionists or dieticians can teach you how to exercise regularly and manage your weight in order to stay healthy.

Conclusion

It is important to note that absent menstruation is a gynecological problem. As stated above, absent menstruation (no menses) can happen for a variety of reasons, the most common being pregnancy.

However, several lifestyle factors such as exercise and body weight levels, among others, may cause no menses.

Also, problems with the reproductive organs or hormonal imbalances may be the cause. So schedule an appointment with your doctor who will help you determine the cause of your amenorrhea.

Further, ensure you adhere to your treatment plan and visit your doctor regularly for follow-up care. Finally, speak with your doctor if your condition fails to improve with lifestyle modifications or medical treatment.

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