What causes amenorrhea?

There are multiple causes for primary amenorrhea once pregnancy, lactation and missed abortion are ruled out. These include:
鈥?anorexia nervosa/bulimia/malnutrition
鈥?extreme obesity
鈥?hyperthyroidism/hypoglycemia
鈥?congenital heart disease
鈥?cystic fibrosis/Crohn鈥檚 disease
鈥?genetic abnormalities
鈥?obstructions: imperforate hymen/vaginal or cervical absence
鈥?ovarian, pituitary (craniopharyngioma) or adrenal tumors
鈥?polycystic ovarian disease
鈥?testicular feminization It is rare for primary amenorrhea to be caused by tumors but it can be a cause and should always be a consideration if other factors are ruled out.

It's not entirely unusual to have a break in your cycle. You should get a check up annually just to be sure. Some reasons:

1. Not enough body fat.
2. Chemical imbalance.
3. Stress.
4. Peri-menopause.
5. Pregnancy.
6. Cysts.

It can range from anything to anorexia and bolemia, Athelete Tiad syndrome(basically anorexia or bolemia plus overdoing exercise), to endometriosis and cancer. It also could just be hormones. I would definetly talk to a doctor if it has been six months and you havent had a period.

Gina and Something are right. You won't be able to know for sure though without going to a doctor. Get checked soon because it could be something more serious.

stress
calorie-restricted diet
eating disorders
strenuous exercise
hormone imbalance
organic disease (e.g.. thyroid disease)
travel

It may reassure you to know that amenorrhea is typically a symptom in and of itself of an underlying condition, but is *rarely* caused by a life-threatening illness. In most instances, symptoms and conditions related to amenorrhea are reversible and treatable.

Secondary amenorrhea happens when a woman who has menstruated previously fails to menstruate for three months. Secondary amenorrhea can be caused by:

Pregnancy (the most common cause)

Breastfeeding (lactation)

Menopause, the normal age-related end of menstruation

Premature ovarian failure (menopause before age 40)

Hysterectomy (surgical removal of the uterus)

Stopping birth control pills

Use of a long-acting progesterone, such as Depo-Provera, for birth control

Tumors of the pituitary gland, especially prolactinomas

Polycystic ovary disease, a condition that causes abnormal levels of estrogen, luteinizing hormone and other hormones

Endocrine disorders such as Cushing's syndrome, in which there are very high levels of cortisol, an adrenal hormone, or hyperthyroidism, abnormally high levels of thyroid hormone

Emotional or physical stress

Rapid weight loss

Obesity

Frequent strenuous exercise

Chronic (long-term) illness, such as colitis, kidney failure or cystic fibrosis

Chemotherapy for cancer

Cysts or tumors in the ovaries

By way of background, amenorrhea affects 2% to 5% of all women of childbearing age in the United States. Female athletes, especially young women, may be more likely to have amenorrhea. While exercise or physical activity itself does not cause amenorrhea, it is more likely to occur in women who exercise very intensely or who increase the intensity of exercise rapidly. Women who engage in sports associated with lower body weight, such as ballet dancing or gymnastics, are more likely to develop amenorrhea than women in other sports.

There is a specific algorithm used to diagnose secondary amenorrhea in an otherwise healthy patient. This includes the following steps:

Algorithm for evaluation of amenorrhea with normal puberty with uterus present -

Obtain a pregnancy test.

If the pregnancy test result is positive, refer the patient to the appropriate specialist.

If the pregnancy test result is negative, obtain TSH, prolactin, FSH and LH levels.

If the TSH level is elevated, the diagnosis is hypothyroidism.

If the prolactin level is elevated, hyperprolactinemia is the diagnosis. Causes include prolactinoma, CNS tumors and medications.

If the FSH level is low, obtain MRI of the head. If the MRI is abnormal, consider hypothalamic disease, pituitary disease or pituitary tumor. If MRI is normal, proceed with clinical evaluation to exclude chronic disease, anorexia nervosa, marijuana or cocaine use, and social or psychological stresses.

If FSH is elevated, ovarian failure is the diagnosis. Obtain a karyotype.

If the karyotype is abnormal, consider pure gonadal dysgenesis, such as Turner syndrome or mosaic or mixed gonadal dysgenesis.

If the karyotype is normal (46 XX), the cause is ovarian failure.

Consider premature ovarian failure, autoimmune oophoritis, exposure to radiation or chemotherapy, resistant ovary syndrome or multiple endocrine neoplasm (MEN) syndrome.

If TSH, prolactin, and FSH levels are within reference range, perform a progestin challenge test.

If withdrawal bleeding occurs, consider anovulation secondary to PCO syndrome.

If no withdrawal bleed occurs, proceed with estradiol priming followed by a progestin challenge.

If the challenge does not induce menses, consider Asherman syndrome or outlet obstruction.

If hirsutism is present, check testosterone, DHEAS, and 17-OH progesterone level.

If the testosterone and DHEAS levels are within the reference range or moderately elevated, perform a progesterone challenge.

If withdrawal bleeding occurs, the diagnosis is PCOS.

If the 17-OH progesterone level is elevated, the diagnosis is adult onset adrenal hyperplasia.

If the testosterone level or DHEAS is 2 or more times higher than the reference range, consider PCO syndrome, hyperthecosis or an androgen secreting tumor of the ovary or adrenal gland

Alternatively, your physician can also follow this algorithm, depending on your personal situation:

Algorithm for evaluation of genital tract abnormalities -

Obtain a pelvic sonography. If the uterus is absent, obtain a karyotype.

If the karyotype is 46,XY, obtain testosterone levels.

If testosterone levels are within reference range or are high (male range), the cause is androgen insensitivity.

If testosterone levels are within reference range or are low (female range), the cause is testicular regression or gonadal enzyme deficiency.

If the karyotype is 46,XX, the cause is m眉llerian agenesis (ie, Rokitansky-Kuster-Hauser syndrome).

Other than pregnancy, constitutional delay, anovulation, and chronic illness, most of the other disorders causing amenorrhea may require referral to a subspecialist for treatment. Many of the treatment methods require surgery or specific therapies. For the adolescent with constitutional delay and anovulation, the goal should be the restoration of ovulatory cycles. If ovulatory cycles are not restored spontaneously, estrogen-progestin therapy is indicated. Reassure patients because the diagnosis of amenorrhea can cause tremendous anxiety.

I hope your doc helps you get to the bottom of it all and your outcome is a positive one. Good luck to you.