Amenorrhoea (absence of periods)

Amenorrhoea: Understanding the Absence of Periods and How We Can Help

Missing a period can mean different things depending on your life stage — and while it’s sometimes completely normal, it can also be a sign that your body is trying to tell you something. Whether you’ve never had periods, they’ve suddenly stopped, or they’ve become irregular, it’s important to listen.

At Happiher, we know that menstrual health is a vital part of overall wellbeing. As a private gynaecologist in London, I support women through the uncertainty and frustration that often comes with conditions like amenorrhoea — offering clear answers and tailored care.

What Is Amenorrhoea?

Amenorrhoea simply means the absence of menstrual periods. It can be classified into two main types:

• Primary amenorrhoea: when a young woman has not started having periods by age 15–16

• Secondary amenorrhoea: when periods that previously started stop for three months or longer

While a missed period now and then isn’t unusual, true amenorrhoea usually signals an underlying hormonal, anatomical, or functional issue that deserves attention.

Classification of Amenorrhea

Amenorrhea can be classified into two main categories: primary and secondary. Primary amenorrhea is further subdivided into two types: congenital and acquired. Congenital primary amenorrhea is caused by genetic disorders, such as Turner syndrome, while acquired primary amenorrhea is caused by factors such as hormonal imbalances or structural abnormalities. Secondary amenorrhea, on the other hand, is caused by factors such as polycystic ovarian syndrome (PCOS), primary ovarian insufficiency (POI), and functional hypothalamic amenorrhea (FHA). The classification of amenorrhea is important for determining the underlying cause and developing an effective treatment plan. A normal menstrual cycle is regulated by the hypothalamic-pituitary-ovarian axis, and any disruption in this axis can lead to amenorrhea. Secondary sexual characteristics, such as breast development and pubic hair growth, are also important indicators of reproductive health. Premature ovarian insufficiency (POI) and premature ovarian failure are two conditions that can lead to secondary amenorrhea. A comprehensive evaluation, including hormone levels, pelvic ultrasound, and thyroid function tests, is necessary to determine the underlying cause of amenorrhea. (Keep keywords: primary ovarian insufficiency, secondary amenorrhea, polycystic ovarian syndrome, primary amenorrhea, functional hypothalamic amenorrhea, menstrual cycle, normal menstrual cycle, secondary sexual characteristics, premature ovarian insufficiency, premature ovarian failure, pelvic ultrasound, hypothalamic pituitary ovarian axis, thyroid function tests, hormone levels, turner syndrome, hypothalamic amenorrhea, underlying cause, structural abnormalities)

What Causes Amenorrhoea, Including Polycystic Ovary Syndrome?

There are many potential causes, which can vary depending on age and medical history. Some of the most common include:

• Pregnancy (the most common cause of secondary amenorrhoea). A urine pregnancy test should be one of the first steps in evaluation due to its ability to quickly identify pregnancy.

• Polycystic Ovary Syndrome (PCOS)

• Excessive exercise (especially among athletes)

• Significant weight loss or eating disorders

• Stress (both physical and emotional)

• Thyroid disorders (underactive or overactive)

• Pituitary gland problems (like a prolactinoma)

• Premature ovarian insufficiency (early menopause)

• Congenital abnormalities (in primary amenorrhoea)

• Adrenal tumors (can cause elevated androgen levels)

• Hormonal contraceptives (can lead to amenorrhoea as a side effect)

• Chronic illness (impacting reproductive health)

In some cases, periods may also stop due to medication, contraception (such as the contraceptive injection), or chronic illnesses.

Symptoms That May Accompany Amenorrhoea

Amenorrhoea itself is a symptom — but depending on the underlying cause, you might also experience:

• Acne or oily skin

• Excess facial or body hair

• Weight changes

• Hot flushes or night sweats

• Vaginal dryness

• Headaches or vision changes

• Pelvic pain or pressure

• Androgen excess, which is associated with conditions like PCOS

A thorough clinical evaluation, including understanding the patient's history and associated symptoms, can help in diagnosing the underlying cause of amenorrhoea.

At Happiher, we look at the full picture, not just the absence of periods.

When Should You See a Gynaecologist?

You should seek advice if:

• You haven’t had a period by age 15–16. It is important to seek advice if a young woman of reproductive age has not had a menstrual period by this time.

• Your menstrual periods stop for three months or longer (and you’re not pregnant or breastfeeding)

• Your periods were always irregular and have now stopped

• You have other symptoms like hair loss, hot flushes, or significant changes in your body

Addressing amenorrhoea early can help prevent longer-term health problems like infertility, osteoporosis (bone thinning), or cardiovascular risks.

How Is Amenorrhoea Diagnosed, Including Primary Ovarian Insufficiency?

Diagnosing the cause of primary or secondary amenorrhoea involves a careful combination of medical history, examination, and testing.

At Happiher, this may include:

• Pregnancy tests to rule out pregnancy as a cause of amenorrhoea

• A detailed consultation about your menstrual history, lifestyle, and overall health

• Physical examination to assess overall health and identify potential causes of amenorrhoea

• Blood tests to check hormone levels (e.g., thyroid function, prolactin, FSH, LH, oestrogen). The anterior pituitary plays a crucial role in hormone release. Measuring sex hormone binding globulin levels is also important. Hypothalamic dysfunction can be a potential cause of amenorrhoea. Elevated prolactin levels are significant in diagnosing pituitary issues. Luteinizing hormone plays a key role in the menstrual cycle. Consulting specialists in reproductive medicine is essential. Thyroid abnormalities can cause amenorrhoea. Pituitary dysfunction is a potential cause of amenorrhoea. Measuring follicle stimulating hormone levels is important. Insulin resistance plays a role in conditions like PCOS. A differential diagnosis is crucial in identifying the underlying cause of amenorrhoea. The adrenal gland plays a role in hormonal imbalances. Gonadotropin releasing hormone is important in the menstrual cycle. Assessing ovarian reserve is crucial. Congenital adrenal hyperplasia can cause amenorrhoea. The hypothalamic pituitary axis is important in regulating menstruation.

• Pelvic ultrasound to examine the uterus and ovaries. Assessing ovarian tissue is important.

• MRI or further imaging if a pituitary cause is suspected. Pituitary tumour can cause hormonal imbalances. Cervical stenosis, intrauterine adhesions, endometrial hyperplasia, and transverse vaginal septum are potential structural abnormalities identified through imaging.

A thorough approach ensures that we identify not just what is happening, but why.

Treatment Options for Amenorrhoea

Treatment depends entirely on the underlying cause and your personal goals, whether that’s restoring cycles, preserving fertility, or managing symptoms like acne or hair growth.

Options may include:

• Hormone replacement therapy (HRT) to alleviate menopause symptoms and maintain bone density. HRT is also important for women with premature ovarian failure as it decreases the risk of cardiovascular disease. Additionally, HRT can be crucial for managing symptoms after natural menopause, which typically occurs around age 50.

• Hormonal therapy to address specific hormonal imbalances. It is important to assess the free androgen index in conditions like PCOS to identify androgen excess.

• Oral contraceptives to regulate menstrual cycles and manage symptoms, particularly in conditions like PCOS. However, caution is advised as they may mask underlying issues such as eating disorders or hormonal imbalances.

Hormonal Therapy for Hormonal Imbalance

• If hormonal imbalance is the cause, treatments may involve regulating or replacing hormones (e.g., the contraceptive pill, HRT if premature menopause is diagnosed). Gonadal dysgenesis, particularly in conditions like Turner syndrome, can also be a potential cause of amenorrhoea due to ovarian insufficiency. Additionally, pituitary adenomas can disrupt hormonal balance by affecting the anterior pituitary gland, and they may require surgical treatment, such as a trans-sphenoidal approach.

Lifestyle Modification for Eating Disorders

• Addressing weight loss, eating disorders, or excessive exercise can often restore natural periods. Additionally, it is important to consider the impact of relative energy deficiency on menstrual health, particularly among elite athletes and women engaging in high levels of exercise.

Treatment of Underlying Conditions

• Managing thyroid disease, PCOS, or pituitary problems with targeted therapies. Addressing thyroid abnormalities, such as administering thyroxine for low thyroid levels, can effectively restore menstruation.

• Evaluating and treating hormonal imbalances, including those caused by a pituitary tumour, which may require further investigations like hypothalamic-pituitary MRI.

Fertility Support

If you wish to conceive and amenorrhoea is affecting your chances, tailored fertility treatments can be offered. It is important to consult specialists in reproductive medicine to ensure accurate assessments and timely interventions for underlying reproductive disorders that may affect long-term health outcomes.

At Happiher, your treatment plan is designed around you — not just your diagnosis.

Living with Amenorrhoea

Amenorrhoea can be confusing and emotionally challenging, especially when it feels like your body isn’t following the patterns you expect. It’s important to know that you’re not alone — and that solutions are available.

Understanding the importance of normal secondary sexual characteristics is crucial in diagnosing reproductive health issues, as their absence can indicate potential developmental problems.

Whether your goal is to restore natural cycles, manage symptoms, or simply understand what’s happening, compassionate and specialist support makes all the difference.

Why Choose Happiher?

If you’re looking for a specialist to help with absent periods, Happiher offers:

• Rapid access to private gynaecology appointments in London

• Comprehensive hormone and pelvic health assessments

• Expertise in reproductive medicine to ensure accurate assessments and timely interventions for underlying reproductive disorders

• Expertise in minimally invasive treatments if needed

• Fertility preservation support when appropriate

• A compassionate, woman-centred approach to diagnosis and care

Dr Kaur brings together advanced clinical expertise with an empathetic, listening-focused practice that ensures you feel heard and supported.

Final Thoughts

Periods are more than a monthly event — they are a vital sign of health. If your cycles have stopped, changed, or never started, seeking expert advice can help protect your health, fertility, and wellbeing for the future.

At Happiher, we’re here to help you navigate your journey with clarity, expertise, and understanding — every step of the way.