Amenorrhea refers to the temporary absence of a menstrual cycle for weeks to months due to a medical cause. It can also refer to menstrual periods that haven’t started for people who should be in puberty.

Most cases of amenorrhea are due to pregnancy. However, amenorrhea can also be caused by several other underlying factors, including an estrogen deficiency.

If this hormone deficiency isn’t addressed, it can increase your risk for osteoporosis. Estrogen deficiency is a common cause of osteoporosis since estrogen is essential to maintaining bone health.

Read on to learn how estrogen levels impact menstruation cycles as well as your bone health and how this hormone deficiency is treated.

How common is amenorrhea?

It’s estimated that less than 1% of people who menstruate in the United States are affected by primary amenorrhea. Around 2% to 5% of people are affected by secondary amenorrhea that’s not caused by pregnancy or menopause.

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Osteoporosis is a condition in which your bones lose mass and density, putting you at greater risk of fractures.

Two core risk factors for osteoporosis are age (being over age 65) and being a postmenopausal woman, which is when estrogen levels naturally decline. However, teens can also have hormonal imbalances that impact bone formation and increase osteoporosis risks.

Estrogen is a hormone that serves several essential functions in your body, including regulating bone formation. If you have lower estrogen levels than considered clinically average, your bones might not become as dense as they could otherwise be. This can contribute to weakness, fractures, and slow healing.

For example, people with amenorrhea are at a higher risk of wrist and hip fractures. In a 2017 study of young women who had low levels of estrogen for 6 months, bone mass density decreased similarly to what you would see in women during the first year of menopause.

For younger people, this decline in estrogen may be due to a hormonal imbalance in adolescence. Teen years are an important time for bone development. In addition to maintaining stable estrogen levels, getting enough calcium and vitamin D, and staying active in your youth help build healthy bones for the rest of your life.

Amenorrhea is classified into two subtypes depending on the underlying cause.

Primary amenorrhea

Most menstruation cycles begin soon after age 12. Primary amenorrhea occurs when someone expecting menstruation in puberty has yet to have their first period by age 16. Sometimes this can occur in people who have differences in sexual characteristics or development (intersex) or those who have low estrogen.

Chromosomal irregularities, and any disruptions to the pituitary gland or hypothalamus can also delay the onset of puberty. In some cases, pregnancy can be the cause.

Secondary amenorrhea

Secondary amenorrhea refers to the absence of periods in previously menstruating people. The American College of Obstetricians and Gynecologists (ACOG) defines amenorrhea as missing your period for 3 or more months.

The most common causes of secondary amenorrhea are pregnancy and breastfeeding, which naturally impact your hormone levels.

Other causes of secondary amenorrhea include:

All these things can have an impact on the way your body’s reproductive hormones are balanced, and some can cause nutrient deficiencies.

Up to 30% of amenorrhea diagnoses in women are classified as hypothalamic amenorrhea, which is typically linked to stress, restrictive eating, and exercise.

Amenorrhea refers to the absence of periods in people who should be menstruating. Menopause refers to the natural tapering off and eventual stoppage of menstruation that happens later in life. This transition can last several years and usually occurs between ages 45 and 55, according to the National Institute on Aging.

People with amenorrhea will usually resume their menstrual cycle with treatment, whereas people with menopause will no longer have periods.

Hormone blockers

Hormone blockers are often used in gender affirming care (GAC) for children and teens. Blockers do exactly that — they block hormones from bringing about puberty.

Going through puberty for a gender you don’t identify with is difficult and can even be traumatizing. Blockers give trans, nonbinary, and gender nonconforming youth more time before puberty to decide what’s right for their body.

If you are on hormone blockers, you will not develop a period. Blockers are for temporary use, as they can also lower bone mass.

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For some people, a couple of missed periods won’t have a huge impact on their long-term health. But any cause of period stoppage (cessation) should be evaluated by a doctor.

The long-term health effects of low estrogen in premenopausal women are still being studied. But researchers often agree that for teenagers and young adults, amenorrhea can create health risks later in life.

Childhood and puberty are crucial periods for our bodies’ development. If estrogen imbalances in childhood and the teen years are not treated, they can have significant future impact on cardiac, skeletal, and reproductive systems.

In addition to interfering with early development, amenorrhea can also present challenges to premenopausal people looking to become pregnant.

It may be difficult for someone with amenorrhea to know if they’re ovulating or if pregnancy is even possible for them at the moment. This can potentially create further emotional stress on top of the underlying medical condition.

Your best treatment option for amenorrhea will depend on the underlying cause, as well as your individual health factors. Determining the cause of your missed periods may involve several diagnostic tests, including those to check for pregnancy and to evaluate your hormone levels.

If an estrogen deficiency is causing your amenorrhea, the most common treatments are dietary supplements and hormone therapy. Estrogen hormone therapy involves taking a synthetic version of the hormone to bring your levels back to a healthy range.

If you have hypothalamic amenorrhea, your doctor will need to determine what’s suppressing the hormone signals to your brain. If a dietary restriction or an eating disorder is causing your amenorrhea, treatment will most likely be structured to address any deficiencies and provide you with support.

If there’s an anatomical reason that prevented your period from ever starting, or if your body’s hormone levels are imbalanced for some other reason, hormone treatment with estrogen, oral contraceptives, or a combination of the two treatments, might be part of your treatment plan.

Reaching out to a doctor rather than assuming the issue will resolve on its own is the safest recommendation. You could be putting yourself at risk for acute and long-term health complications, such as osteoporosis, by not getting evaluated for amenorrhea.

Low estrogen levels are a common cause of both amenorrhea and osteoporosis. Having untreated amenorrhea puts you at increased risk of osteoporosis.

Amenorrhea and subsequent low bone mass can affect teens going through puberty, postmenopausal women, and others.

No matter the underlying cause of amenorrhea, there is effective treatment available.

Taking estrogen hormone therapy to boost your low levels can return bones to full health and prevent future complications. Sometimes, another underlying health condition causing low estrogen needs to be addressed.

Pay close attention to your menstrual cycles and note any irregularities. Parents should consult a doctor if their child’s menstruation hasn’t begun as expected to check for estrogen deficiency.