What are the treatments for amenorrhea?

The treatment for amenorrhea depends on the underlying cause, as well as the health status and goals of the individual.

If primary or secondary amenorrhea is caused by lifestyle factors, your health care provider may suggest changes in the areas below:

  • Weight. Being overweight or severely underweight can affect your menstrual cycle. Attaining and maintaining a healthy weight often helps balance hormone levels and restore your menstrual cycle.
  • Stress. Assess the areas of stress in your life and reduce the things that are causing stress. If you can't decrease stress on your own, ask for help from family, friends, your health care provider, or a professional listener such as a counselor.
  • Level of physical activity. You may need to change or adjust your physical activity level to help restart your menstrual cycle. Talk to your health care provider and your coach or trainer about how to train in a way that maintains your health and menstrual cycles.

Be aware of changes in your menstrual cycle and check with your health care provider if you have concerns. Keep a record of when your periods occur. Note the date your period starts, how long it lasts, and any problems you experience. The first day of bleeding is considered the first day of your menstrual cycle.

For primary amenorrhea, depending on your age and the results of the ovary function test, health care providers may recommend watchful waiting. If an ovary function test shows low follicle-stimulating hormone (FSH) or luteinizing hormone (LH) levels, menstruation may just be delayed. In females with a family history of delayed menstruation, this kind of delay is common.1

Primary amenorrhea caused by chromosomal or genetic problems may require surgery. Women with a genetic condition called 46, XY gonadal dysgenesis have one X and one Y chromosome, but their ovaries do not develop normally. This condition increases the risk for cancer developing in the ovaries. The gonads (ovaries) are often removed through laparoscopic surgery to prevent or reduce the risk of cancer.2

Treatment for secondary amenorrhea, depending on the cause, may include medical or surgical treatments or a combination of the two.

Common medical treatments for secondary amenorrhea include:3

  • Birth control pills or other types of hormonal medication. Certain oral contraceptives may help restart the menstrual cycle.
  • Medications to help relieve the symptoms of PCOS. Clomiphene citrate (CC) therapy is often prescribed to help trigger ovulation.4
  • Estrogen replacement therapy (ERT). ERT may help balance hormonal levels and restart the menstrual cycle in women with primary ovarian insufficiency (POI) or Fragile X-associated primary ovarian insufficiency (FXPOI).5 Women with FXPOI often experience symptoms of menopause, such as hot flashes and night sweats. ERT replaces the estrogen a woman's body should be making naturally for a normal menstrual cycle. In addition, ERT may help women with FXPOI lower their risk for the bone disease osteoporosis.6 ERT can increase the risk for uterine cancer, so your health care provider may also prescribe progestin or progesterone to reduce this risk.

In general, medications are safe, but they can have side effects, some of which may be serious. You should discuss side effects and risks with your health care provider before deciding on any specific medical treatment.

Surgical treatment for amenorrhea is not common, but may be recommended in certain conditions. These include:

  • Uterine scarring. This scarring sometimes occurs after removal of uterine fibroids, a cesarean section, or a dilation and curettage (D&C), a procedure in which tissue is removed from the uterus to diagnose or treat heavy bleeding or to clear the uterine lining after a miscarriage.7 Removal of the scar tissue during a procedure called a hysteroscopic resection can help restore the menstrual cycle.8

Pituitary tumor. Medications may be recommended to shrink the tumor. If this does not work, surgery may be necessary to remove the tumor. Pituitary tumors are not cancerous, but they can cause problems as they grow. Pituitary tumors can put pressure on surrounding blood vessels and nerves such as the optic nerve and may result in loss of vision. 

Most of the time, pituitary tumors are removed through the nose and sinuses. Radiation therapy may be used to shrink the tumor, either in combination with surgery or, for those who cannot have surgery, by itself.

Citations

  1. Master-Hunter, T., & Heiman, D. L. (2006). Amenorrhea: Evaluation and treatment. American Family Physician, 73, 1374–1382. Retrieved May 31, 2016, from http://www.aafp.org/afp/2006/0415/p1374.html external link
  2. Verkauskas, G., Macianskyte, D., Janciauskas, D., Preiksa, R. T., Verkauskiene, R., & Jaubert, F. (2009). Diagnosis and management of 46,XY mixed gonadal dysgenesis and disorder of sexual differentiation. Medicina,45(5), 357–364. Retrieved May 31, 2016, from http://www.ncbi.nlm.nih.gov/pubmed/19535881
  3. American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins—Gynecology. (2013). Practice bulletin no. 136: Management of abnormal uterine bleeding associated with ovulatory dysfunction. Obstetrics and Gynecology, 122(1), 176–185.
  4. Practice Committee of the American Society for Reproductive Medicine (PC-ASRM). (2006). Effectiveness and treatment for unexplained infertility. Fertility and Sterility, 86(suppl 4), S111–S114. Retrieved November 22, 2016, from https://www.asrm.org/practice-guidance/practice-committee-documents/current-evaluation-of-amenorrhea/ external link
  5. NIH. (2010, April). Most young women with menopause-like condition retain store of eggs. Retrieved May 31, 2016, from http://www.nih.gov/news/health/apr2010/nichd-26.htm
  6. Rebar, R. W. (2009). Premature ovarian failure. Obstetrics and Gynecology, 113(6), 1355–1363.
  7. ACOG. (2016). Dilation and curettage. Retrieved May 31, 2016, from http://www.acog.org/~/media/For%20Patients/faq062.pdf?dmc=1&ts=20120606T1418144478 external link (PDF 69 KB)
  8. Gambadauro, P., Gudmundsson, J., & Torrejon, R. (2012). Intrauterine adhesions following conservative treatment of uterine fibroids. Obstetrics and Gynecology International,2012, 1–6. Retrieved May 31, 2016, from http://www.hindawi.com/journals/ogi/2012/853269/ external link
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