Amenorrhea

What it is

Amenorrhea is the absence of menstruation. It is called primary when the first period has not occurred by age 15, and secondary when a woman who has already menstruated goes three months or more without a period, once pregnancy has been ruled out. The causes vary: hormonal changes such as PMOS, elevated prolactin and thyroid disorders, significant weight loss, intense physical exercise, stress, use of certain medications and contraceptives, premature ovarian insufficiency (early menopause), abnormalities of the uterus and vaginal canal, among others. The investigation includes the clinical history, physical examination, blood tests with hormone levels and ultrasound. Treatment is directed at the cause and the woman's goals — regulating the cycle, protecting bone health, treating the underlying condition or planning a pregnancy.

Most common symptoms

• Absence of menstruation for three months or more
• First period that has not occurred by age 15
• Nipple discharge outside of breastfeeding
• Hot flashes and vaginal dryness
• Acne, excess hair growth or hair loss
• Headache or vision changes
• Significant weight loss or gain

Causes and risk factors

• Pregnancy, breastfeeding and use of contraceptives
• Polyendocrine metabolic ovarian syndrome (PMOS)
• Elevated prolactin and thyroid disorders
• Weight loss, intense physical exercise and stress
• Premature ovarian insufficiency (early menopause)
• Abnormalities of the uterus, vaginal canal or hymen

How it is diagnosed

The investigation begins by ruling out pregnancy. Your gynecologist assesses the menstrual history, pubertal development, weight, exercise routine, stress level and medications in use, and performs a physical and gynecological exam. Blood tests measure hormones such as FSH, LH, estradiol, prolactin, thyroid hormones and androgens, and pelvic ultrasound assesses the uterus and ovaries. Depending on the results, pituitary MRI, genetic testing or other additional tests may be ordered.

How we treat it at Femi Saúde

Treatment is directed at the identified cause. In PMOS, the Femi Saúde gynecology team may recommend lifestyle changes and hormonal contraceptives or progestins to regulate the cycle. When prolactin or thyroid levels are altered, the focus is on treating the underlying condition. In cases linked to weight, exercise or stress, care includes nutritional guidance, adjustment of physical activity and psychological support, with multidisciplinary follow-up. In premature ovarian insufficiency, hormone therapy protects bone health and relieves the symptoms of estrogen deficiency. Anatomical abnormalities may require procedures such as hysteroscopy. Women who wish to become pregnant receive specific guidance. The plan is individualized.

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