“A menstrual cycle that is not in use for weeks to months is called Amenorrhea. It can also refer to 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.”

Learn how estrogen levels affect 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.

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.

The underlying cause of Amenorrhea can be classified into two different types.

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:

Some of these things can cause your body to have deficiencies in some vitamins.

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 hormones, you won’t have a period. Blockers can be used temporarily to lower bone mass.”

“Some people don’t have a huge impact on their health because of a couple of missed periods. Period cessation should be evaluated by a doctor.”

There are still studies on the long-term effects of low estrogen on women. Researchers agree that amenorrhea can cause health risks for teenagers and young adults.

Our bodies are developed during childhood and puberty. If the teen years are not treated, they can have a significant impact on the future of the cardiovascular, skeletal, and reproductive systems.

Pre-menopausal people looking to become pregnant can be affected by amenorrhea.

It may be difficult for someone with amenorrhea to know if they are pregnant or not at the moment. This can cause more emotional stress on top of the underlying medical condition.

Your individual health factors and underlying cause will determine your treatment option for amenorrhea. Diagnostic tests may be used to determine the cause of your missed periods, including those to check for pregnant women and to evaluate your hormones.

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 is suppressing the hormone signals to your brain. If you have an eating disorder or a restriction on food, treatment will most likely be structured to address any deficiencies and provide you with support.

“If there is an underlying reason that prevented your period from ever starting, or if your body’s hormones are not in balance, hormone treatment with estrogen, oral contraceptives, or a combination of the two treatments, might be part of your treatment plan.”

It is the safest recommendation to reach out to a doctor. You could be putting yourself at risk for long-term health problems by not getting evaluated for amenorrhea.

Amenorrhea and osteoporosis are caused by low estrogen levels. You are at increased risk of osteoporosis if you have amenorrhea.

Teens going through puberty can be affected by Amenorrhea and low bone mass.

There is effective treatment for amenorrhea.

Taking estrogen hormone therapy can help you return bones to full health. Sometimes a health condition that causes low estrogen needs to be addressed.

“Take care of your menstrual cycles and note any anomalies. If your child’s menstruation hasn’t begun as expected, you should consult a doctor.”