• In most cases, amenorrhea has natural causes, such as pregnancy or breastfeeding.
• Missing periods can also be caused by hormonal imbalances, stress, weight changes, or other factors.
• If there are certain signs, a medical examination is advisable.
• There are different treatment approaches depending on the cause of the amenorrhea.

If you don't have a period, doctors call it amenorrhea. This is the medical term for the absence of a menstrual period. In most cases, the reasons lie in natural processes such as pregnancy or menopause.

However, the absence of menstruation can also be caused by factors such as competitive sports, stress, depression, weight changes or hormonal disorders. 

There are two forms of amenorrhea:

The cycle is determined by some areas of the brain by regulating the production of sex hormones. The pituitary gland and hypothalamus can control the production of the hormones GnRH, LH and FSH. The ovaries can be responsible for the hormones estrogen, androgen and progesterone. The follicle-stimulating hormone FSH can stimulate the growth of egg cells in the ovary at the beginning of the menstrual cycle. During each menstrual cycle, an egg cell normally matures. The cell should be surrounded by an envelope that produces estrogens.

Estrogen production can affect the lining of the uterus getting ready for a fertilized egg. Normally, the luteinizing hormone LH is then released and the mature egg cell can migrate into the fallopian tube. The shell usually turns back into the corpus luteum and the cells it contains can ensure increased production of progesterone - the corpus luteum hormone.

If fertilization does not occur, the menstrual period can occur with the expulsion of endometrium and blood. The hormonal status of progesterone and the other hormones should go down and a new cycle can begin.

In the following we will show you the possible causes for the missed menstrual period.

Missing a period may be due to pregnancy. The fertilized egg then implants itself in the uterus and there is no menstrual period. If childbirth was accompanied by heavy blood loss, the pituitary gland may become dysfunctional. This leads to missed periods over a longer period of time.

Other natural causes of secondary amenorrhea can be breastfeeding and menopause. Menstruation can also be absent or delayed during puberty. Many girls do not have a regular menstrual cycle during puberty.

The psyche can influence the messenger substances and hormones and thus also the cycle. If you are under constant or severe stress, you may miss your period. It is also possible that during a period of mourning or under professional or personal pressure, the hormones become imbalanced and this can lead to secondary amenorrhea. The same can apply to depression, anxiety, psychosis and other mental disorders.

Anorexia, binge eating, bulimia or an extreme diet can affect the hormones, which is why menstruation can stop. The hormones sometimes also react to extreme sports, so that competitive athletes can often have to deal with secondary amenorrhea.

Some diseases and disorders can lead to the absence of menstruation. In hormone disorders, either male sex hormones predominate or the body produces too few female sex hormones. Hormonal imbalances can be caused by brain disorders such as encephalitis or brain tumors, as well as ovarian tumors or other ovarian disorders. Kidney disease, diabetes, thyroid disease, or damage to the uterus can also be causes of missed periods.

Furthermore, congenital malformations of the ovaries can lead to amenorrhea. Some women experience menopause in their 35s and 40s. Stress, smoking, severe underweight and mental disorders are possible triggers for premature menopause. In addition, diseases such as Cushing's disease, Addison's disease and osteoporosis can cause the symptom of absent menstruation.

There are drugs that can affect hormone balance. These include contraceptives such as the hormonal spiral, the contraceptive pill and the three-month injection. Sometimes a woman doesn't have a period for a few months after she stops taking the pill. This can sometimes be the case if the birth control pill has been taken for a long time.

Psychotropic drugs can also cause a missed period. For example, tricyclic antidepressants can affect prolactin secretion and cause secondary amenorrhea. A missed menstrual period or an irregular cycle are also possible due to prolonged intake of cortisone preparations or medication that lowers blood pressure.

In addition, hormone treatments as part of cancer therapy often lead to the absence of menstruation, since cancer drugs can cause premature menopause. Radiation therapy can also have a negative effect on hormones and thus on the menstrual cycle. Furthermore, the side effects of anabolic steroids in women can include amenorrhea because male sex hormones are taken with the drugs.

You should have a doctor examine you if you have these signs or factors:

• Up to the age of 13 there are no signs of puberty such as a growth spurt or development of the breasts
• Up to the age of 15 there was no menstruation
• Menstrual periods stopped three times in a row
• There are fewer than nine periods per year
• The course of the menstrual cycle changes suddenly
• The period is missed because pregnancy is possible
• Since taking a medication, the menstrual period has stopped
• Unpleasant and negative symptoms such as pain appear

In addition, the doctor will want to know if you exercise, what your eating habits are, and if you take any medication.

Typically, testing for amenorrhea includes a pregnancy test and physical exam. For example, your pelvis will be examined so that the doctor can identify any abnormalities in the reproductive organs. He also determines the development of the sexual organs through the pelvic examination.

Your gynecologist will also check for signs that may be causing amenorrhea. 

These include:

• Milky discharge from the nipples - Some medications can increase prolactin levels, which can stimulate milk production. A pituitary disorder can also cause milky discharge.
• Night sweats, vaginal dryness and hot flashes – These symptoms may indicate premature menopause or ovarian dysfunction. These symptoms can also occur with chemotherapeutic drugs or radiation.
• Tremor with weight gain or loss - If you have a thyroid problem, you may experience tremors with weight gain and sluggishness, or you may lose weight.
• Headaches, vision problems such as double vision and hearing loss – Tumors in the pituitary gland or in the hypothalamus can lead to these symptoms.
• formation of male characteristics – Tumors, some medications and polycystic ovary syndrome can lead to growing muscles, excessive body hair and a deep voice

Depending on the suspicion, these tests can be done:

• Pregnancy test: A pregnancy test is always part of the examination for amenorrhea in girls and women of childbearing age.
• Ultrasonic: In girls with suspected primary amenorrhea, an ultrasound scan is used to check for a birth defect.
• Imaging methods: Various areas of the brain, the pituitary gland, the ovaries, the adrenal glands or the abdomen are examined using CT or MRI.
• blood test: Blood tests measure levels of prolactin, follicle-stimulating hormone, male hormones, and thyroid hormones.
• urine test: Metabolic or hormonal disorders can also be detected in the urine.
• tissue sample: Genetic disorders can be detected on the basis of a tissue sample.
• reflections: Depending on the suspicion, a pelviscopy or laparoscopy is necessary. These are reflections of the internal sex organs.
• hormone doses: Hormones may be administered to induce menstrual bleeding. If menstruation begins as a result of hormone administration, the cause of amenorrhea is probably a malfunctioning hormone system. If the hormones cannot trigger menstrual bleeding, the reason may be a structural abnormality or a disorder in the uterus.