What Causes Amenorrhea? Is it okay to leave it alone? When to go to the hospital and how to treat

"Speaking of which, I haven't had my period yet this month... When was the last time I had my period?"

If you don't get your period for a while, you may have a condition called amenorrhea . You may think that not having a menstruation is easy and good, but if you leave it unattended, it can lead to hormonal imbalance and various health problems.

In addition, amenorrhea may be caused by various diseases.

Find out in this article

  • what is amenorrhea like
  • Types of amenorrhea
  • Causes of Amenorrhea
  • When to go to the hospital and how to treat

Read this article to learn more about amenorrhea.

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What is amenorrhea

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Amenorrhea is the absence of menstruation for 3 months without pregnancy .

A normal menstrual cycle is 25 to 38 days before the next menstruation. On the other hand, when the interval between menstruation is less than 25 days or more than 39 days and less than 3 months, it is called irregular menstruation.

There are two types of amenorrhea: primary amenorrhea, in which menstruation has not occurred even once at the age of 18, and secondary amenorrhea, in which menstruation does not occur due to stress or illness. .

Please refer to the table below for details on primary amenorrhea and secondary amenorrhea.

menstrual experience

Guideline for diagnosis

Symptoms (often asymptomatic)

primary amenorrhea


18 years old and no menstruation

No breast development, no pubic hair

secondary amenorrhea

can be

no menstruation for 3 months

Headache, nausea, dizziness, visual disturbance (*)

* Seen when the cause is a pituitary tumor

In addition, symptoms such as hirsutism and acne may occur due to an increase in male hormones.

If you ignore either amenorrhea, you may miss the disease or cause infertility, so early measures are necessary.

Causes of Amenorrhea

I often hear that stress and excessive dieting cause irregular menstruation or amenorrhea. Certainly stress and weight gain and loss can cause amenorrhea. However, the causes of amenorrhea are not limited to stress and weight gain or loss, but can also be caused by gynecological or endocrine diseases, or the side effects of the drugs you normally use .

If amenorrhea is left untreated, there is a risk of overlooking illnesses or side effects of medications. Find out more about the causes of infertility here.

Major Causes of Primary Amenorrhea

The frequency of primary amenorrhea is 0.3-0.4%, which is quite rare. The main causes of primary amenorrhea are said to be chromosomal abnormalities, genital malformations, and hormonal abnormalities.

Excessive exercise can also cause amenorrhea.

In rhythmic gymnastics, gymnastics, and long-distance athletics, amenorrhea and amenorrhea caused by low body weight and stress fractures caused by excessive load are regarded as problems.

Because the diagnosis of primary amenorrhea is age-based, it is not diagnosed until age 18. However, 98% of Japanese women are said to have their first menstrual period by the age of 15, so if you are 16 and still do not have menstruation, you should consult a gynecologist.

Major Causes of Secondary Amenorrhea

Most of the causes of secondary menstruation without menstruation for 3 months or more are due to abnormalities in hormone secretion from the hypothalamus due to stress, heavy weight gain and loss, and excessive exercise . Such amenorrhea is called hypothalamic amenorrhea. call.

In a woman's body, various hormones stimulate the hypothalamus → pituitary gland → ovaries in order, and ovulation and menstruation occur.

If some kind of problem occurs between the brain hypothalamus → pituitary gland → ovaries, the hormone balance will be disturbed, resulting in irregular menstruation or hypothalamic amenorrhea.

In rare cases, secondary amenorrhea can also be caused by other diseases, such as a pituitary tumor or abnormal thyroid hormone secretion.

In addition, some drugs used for psychosis such as depression, drugs used for digestive symptoms, and anticancer drugs cause irregular menstruation and secondary amenorrhea1). However, use of these drugs does not necessarily result in secondary amenorrhea, so please consult with your doctor before use.

when to go to hospital

When menstruation does not come easily, you may be wondering when to go to the hospital.

If you think you might be pregnant, take a pregnancy test a week after your expected period. If you can confirm that you are not pregnant, please visit a gynecologist about 3 months after your last menstrual period .

Also, since the normal menstrual cycle is 25 to 39 days, if the menstrual cycle is shorter than 25 days or longer than 39 days, it may be irregular menstruation, so it is recommended to go to a gynecologist as soon as possible.

If you usually record your basal body temperature, you can check if you are ovulating by looking at the basal body temperature chart, so please show the basal body temperature chart to your doctor.

If there is a possibility of primary amenorrhea, if menstruation does not come even after turning 16, please consult a gynecologist.

As previously mentioned, amenorrhea can have many different causes. Please consult a gynecologist without neglecting menstrual irregularities or amenorrhea.

what kind of treatment

When treating amenorrhea at a hospital, treatment methods are selected according to the cause of amenorrhea and whether or not you wish to become pregnant .

Treatment for primary amenorrhea (no menstruation by age 18)

  • If the vagina or hymen is closed: Surgery
  • In case of hormonal imbalance・・・hormone therapy
  • If radical cure is difficult due to chromosomal abnormalities・・・Counseling

Treatment of secondary amenorrhea (absence of menses for 3 months or more)

  • If you want to get pregnant, use an ovulation inducer to stabilize your menstrual cycle.
  • If you do not wish to become pregnant: treatment of the underlying disease, hormone therapy
  • If you have weight loss due to stress or anorexia: Counseling

A combination of the above treatments may also be selected.

Also read the following articles
How to fix hormonal imbalance


How was it. Amenorrhea itself is a common occurrence, but if it is left untreated, it can lead to infertility and can lead to serious adverse effects on our bodies .

If you think that menstruation is not coming, first try to refresh yourself and reduce stress. If 3 months have passed since your last menstrual period, please consult a gynecologist.

If you are a junior high school student and are worried about not having your period, please go to a gynecologist as soon as possible. Don't worry, the hospital is not a scary place. Knowing the reason why menstruation does not come and receiving the correct treatment will lead to the growth of the body in the future.

If you keep a basal body temperature chart on a regular basis, it will be convenient when you go to the gynecologist. If you are worried about menstruation, it is recommended to make it a habit to measure your basal body temperature every morning.

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1) Mariko Ogawa, Kiyoshi Takamatsu Menstruation-related symptoms that should be known in psychosomatic medicine Special issue Drug-induced amenorrhea Psychosomatic Medicine Vol.60 (2020) No.6 p509-514 https://www.jstage.jst.go. jp/article/jjpm/60/6/60_509/_pdf/-char/ja