Merck Manual

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Some Causes and Features of Amenorrhea

Some Causes and Features of Amenorrhea


Common Features†


Hormonal disorders

Warm, moist skin, difficulty tolerating heat, excessive sweating, an increased appetite, weight loss, bulging eyes, double vision, shakiness (tremor), and frequent bowel movements

Sometimes an enlarged thyroid gland (goiter)

Blood tests to measure thyroid hormone levels

Difficulty tolerating cold, a decreased appetite, weight gain, coarse and thick skin, loss of eyebrow hair, a puffy face, drooping eyelids, fatigue, sluggishness, slow speech, and constipation

Blood tests to measure thyroid hormone levels

Vision problems and headaches, particularly at night

Sometimes production of breast milk in women who are not breastfeeding (galactorrhea)

Blood test to measure prolactin levels

MRI of the brain

Development of masculine characteristics (such as excess body hair, a deepened voice, and increased muscle size)

Irregular or no menstrual periods, acne, excess fat in the torso, and dark, thick skin in the underarm, on the nape of the neck, and in skinfolds

Blood tests to measure hormone levels

Ultrasonography of the pelvis to look for abnormalities in the ovaries

Symptoms of menopause, including hot flashes, night sweats, and vaginal dryness and thinning of vagina

Risk factors such as removal of the ovaries, chemotherapy, or radiation therapy directed at the pelvis (the lowest part of the torso)

Blood tests to measure levels of estrogen and other hormones

For women under 35, examination of chromosomes in a sample of tissue (such as blood)

Tumors that produce male hormones (androgens), usually in the ovaries or adrenal glands

Development of masculine characteristics, acne, and genitals that are not clearly male or female ( ambiguous genitals Symptoms Symptoms )

CT, MRI, or ultrasonography

Structural disorders

Birth defects:

Primary amenorrhea

Normal development of breasts and secondary sexual characteristics

Abdominal pain that occurs in cycles and bulging of the vagina or uterus (because menstrual blood is blocked and accumulates)

A doctor's examination

Hysterosalpingography (x-rays taken after a contrast agent is injected into the uterus and fallopian tubes) or hysteroscopy (insertion of a viewing tube through the vagina to view the uterus)

Asherman syndrome (scarring of the lining of the uterus due to an infection or surgery)

Secondary amenorrhea

Often repeated miscarriages and infertility

Sonohysterography (ultrasonography after fluid is infused into uterus), hysterosalpingography, or hysteroscopy

Sometimes if results are unclear, MRI

Secondary amenorrhea

Pain, vaginal bleeding, constipation, repeated miscarriages, and an urge to urinate frequently or urgently


Sometimes MRI if fibroids are difficult to view or look abnormal

Secondary amenorrhea

Vaginal bleeding

Ultrasonography, sonohysterography, or hysteroscopy

Conditions that cause the hypothalamus to malfunction

Symptoms related to the specific disorder

A doctor's examination

Usually various tests specific to the type of disorder

Excessive exercise

Often a low body weight and body fat

A doctor's examination

Symptoms related to the specific disorder

A doctor's examination

Usually examination, culture, and other tests of a tissue sample to identify the microorganism

Withdrawal from usual activities

Sluggishness or sadness

Sometimes weight gain or weight loss and difficulty sleeping or too much sleep

A doctor's examination

Often low body weight and body fat or a significant loss of weight over a short time

A doctor's examination


A stressful life event, difficulty concentrating, worry, and sleep problems (too much or too little)

A doctor's examination

* Drugs can also cause amenorrhea (see Table below).

† Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present.

‡ High levels of prolactin (a hormone that stimulates the breasts to produce milk) can result in no periods.

CT = computed tomography; MRI = magnetic resonance imaging.