Amenorrhea: What missing periods mean and what to do next

Missing a period now and then can happen. But if your period stops for months, that’s called amenorrhea and it’s worth checking out. This guide explains the most common causes, how doctors diagnose it, basic treatments, and simple steps you can try at home while you sort things out.

Common causes you should know

First, always rule out pregnancy — it’s the simplest cause. After that, think about three big groups: hormonal, structural, and lifestyle-related reasons. Hormonal causes include polycystic ovary syndrome (PCOS), thyroid problems, and high prolactin from a pituitary issue. Structural causes are rarer but include scarring of the uterus (Asherman’s) or congenital differences. Lifestyle-driven amenorrhea shows up when your body lacks energy: low body weight, rapid weight loss, or excessive exercise that disrupts the brain signals that trigger periods (hypothalamic amenorrhea). Certain medicines — some antidepressants, antipsychotics, chemotherapy, or high-dose steroids — can also stop periods.

How doctors check for the cause

Start with a pregnancy test. If that’s negative, a clinician will take your history (age, weight changes, stress, exercise, medications) and do a physical exam. Blood tests commonly include hCG, TSH (thyroid), prolactin, and FSH/LH to check ovarian function. An ultrasound helps assess the uterus and ovaries. Sometimes doctors order more specialized tests or refer you to an endocrinologist or gynecologist. If a pituitary issue is suspected, an MRI might be needed.

Treatment targets the cause. If weight loss or heavy training is the problem, restoring calories and easing workouts often brings periods back. For PCOS, doctors commonly suggest lifestyle changes, combined hormonal birth control to regulate bleeding, or medications like metformin if insulin resistance is present. High prolactin usually responds well to dopamine agonists (like cabergoline). If low estrogen is a concern, short-term hormonal therapy can protect bone health. Structural issues may require surgical repair.

Worried about fertility? Amenorrhea often means you’re not ovulating. If you want to get pregnant, tell your doctor early. Treatments that restore ovulation (letrozole, clomiphene) or assisted reproduction are options depending on the cause. Time matters more if you’re older or have other health issues.

Practical steps you can try now: take a home pregnancy test, track any symptoms (weight, hair growth, headaches, vision changes), review current medications, reduce extreme exercise, and focus on steady, nutritious eating. Keep a record of dates and symptoms to share with your clinician — it speeds up diagnosis.

See a doctor if your period hasn’t returned after three months, if you never had a period by age 15, or if you have additional signs like sudden weight changes, excessive hair growth, severe headaches, or vision problems. Start with your primary care provider or gynecologist — they’ll guide the right tests and treatment so you can get back to normal sooner.