Amenorrhoea (absence of periods)

Amenorrhoea: What It Means and How We Can Help

Missing a period can mean different things depending on your stage of life — 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 stopped suddenly or they’ve become irregular, you need to listen.

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

What Is Amenorrhoea?

Amenorrhoea means no periods. It can be divided 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

A missed period every now and then isn’t unusual, true amenorrhoea usually means there’s a hormonal, anatomical or functional issue that needs attention.

Amenorrhea Types

Amenorrhea can be divided into two main types: primary and secondary. Primary amenorrhea is further sub-divided into two types: congenital and acquired. Congenital primary amenorrhea is caused by genetic disorders like Turner syndrome, acquired primary amenorrhea is caused by hormonal imbalances or structural abnormalities. Secondary amenorrhea is caused by factors like polycystic ovarian syndrome (PCOS), primary ovarian insufficiency (POI) and functional hypothalamic amenorrhea (FHA). The classification of amenorrhea is important to determine the underlying cause and develop a treatment plan. A normal menstrual cycle is regulated by the hypothalamic-pituitary-ovarian axis and any disruption in this axis can cause amenorrhea. Secondary sexual characteristics like 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 cause secondary amenorrhea. A full evaluation including hormone levels, pelvic ultrasound and thyroid function tests is needed 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 possible causes which can vary depending on age and medical history. Some of the most common are:

• Pregnancy (the most common cause of secondary amenorrhea). A urine pregnancy test should be one of the first steps in evaluation as it can quickly rule out pregnancy.

• Polycystic Ovary Syndrome (PCOS)

• Excessive exercise (especially among athletes)

• Significant weight loss or eating disorders

• Stress (physical and emotional)

• Thyroid disorders (underactive or overactive)

• Pituitary gland problems (like a prolactinoma)

• Premature ovarian insufficiency (early menopause)* Congenital abnormalities (in primary amenorrhea)

• Adrenal tumors (can cause high androgen levels)

• Hormonal contraceptives (can cause amenorrhea as a side effect)

• Chronic illness (affecting reproductive health)

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

Symptoms That May Accompany Amenorrhea

Amenorrhea itself is a symptom — but depending on the underlying cause you may 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 full clinical evaluation including understanding the patient’s history and associated symptoms can help in diagnosing the underlying cause of amenorrhea.

At Happiher we look at the whole 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 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 amenorrhea early can prevent longer term health problems like infertility, osteoporosis (bone thinning) or cardiovascular risks.

How Is Amenorrhea Diagnosed, Including Primary Ovarian Insufficiency?

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

At Happiher, this may include:

• Pregnancy test to rule out pregnancy as a cause of amenorrhea

• Detailed consultation covering menstrual history, lifestyle, and overall health

• Physical examination to assess general health and identify possible underlying causes

• Blood tests to evaluate hormone levels, including:

  • Thyroid function

  • Prolactin

  • Follicle-stimulating hormone (FSH)

  • Luteinizing hormone (LH)

  • Oestrogen

  • Sex hormone-binding globulin (SHBG)

  • Insulin levels (to assess for insulin resistance, particularly in PCOS)

  • Additional markers to assess ovarian reserve and adrenal function

These tests help evaluate the role of the hypothalamic-pituitary-ovarian axis, which is crucial for menstrual regulation. Abnormalities in this axis—such as hypothalamic dysfunction, pituitary tumours, or primary ovarian insufficiency—can lead to amenorrhea. Elevated prolactin may indicate pituitary issues. Thyroid abnormalities, adrenal gland disorders (such as congenital adrenal hyperplasia), and gonadotropin-releasing hormone (GnRH) dysfunction are also potential contributors.

• Pelvic ultrasound to examine the uterus and ovaries, assess ovarian tissue, and rule out anatomical abnormalities

• MRI or further imaging if a pituitary cause is suspected. This can help detect pituitary tumours or other structural issues.

Structural causes such as cervical stenosis, intrauterine adhesions, endometrial hyperplasia, and transverse vaginal septum may also be identified through imaging.

A comprehensive differential diagnosis is essential to identifying the root cause and guiding appropriate treatment.

A thorough approach ensures we don’t just identify what is happening but why.

Treatment Options for Amenorrhea

Treatment depends on the underlying cause and your goals, whether that’s to restore cycles, preserve fertility or manage symptoms like acne or hair growth.

Options may include:

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

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

• Oral contraceptives to regulate cycles and manage symptoms especially in conditions like PCOS. However caution is advised as they may mask underlying issues like 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 pill, HRT if premature menopause is diagnosed). Gonadal dysgenesis particularly in conditions like Turner syndrome can also be a cause of amenorrhea due to ovarian insufficiency. Pituitary adenomas can disrupt hormonal balance by affecting the anterior pituitary gland and may require surgical treatment like trans-sphenoidal approach.

Lifestyle Modification for Eating Disorders

• Addressing weight loss, eating disorders or excessive exercise can often restore natural periods. It’s also important to consider the impact of relative energy deficiency on menstrual health especially in elite athletes and women who exercise at high levels.

Treatment of Underlying Conditions

• Managing thyroid disease, PCOS or pituitary problems with targeted therapies. Addressing thyroid abnormalities like administering thyroxine for low thyroid levels can 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 want to conceive and amenorrhea is affecting your chances, tailored fertility treatments can be offered. It’s 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 Amenorrhea

Amenorrhea 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 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 developmental problems.

Whether you want to restore natural cycles, manage symptoms or just 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 kind, woman-led approach to diagnosis and treatment

Dr Kaur combines her medical expertise with a listening ear so you feel seen and heard.

Conclusion

Periods are more than a monthly occurrence — they are a sign of life. If your periods have stopped, changed or never started, get expert advice to protect your health, fertility and wellbeing for the future.

At Happiher we’re with you every step of the way.