Absent periods (amenorrhea)

For a lay person:

Amenorrhea means not having periods, either because they never started or because they have stopped for several months. Pregnancy is the most common cause, but stress, weight loss, heavy exercise, hormone conditions and some medicines can also stop periods.

For a trained medical person:

Primary amenorrhoea is absence of menarche by 15, and secondary is cessation for three months or more after regular cycles. Causes include pregnancy, hypothalamic suppression, polycystic ovary syndrome, hyperprolactinaemia, thyroid disease, premature ovarian insufficiency, uterine adhesions and congenital anomalies; evaluation starts with a pregnancy test then FSH, LH, prolactin, TSH and androgens, with imaging as indicated. Treatment targets the cause, including weight restoration, hormone therapy and fertility treatment.

In Chinese medicine:

Liu and Tseng's textbook differentiates this condition into these patterns: Blood Stasis at Uterus, Blockage at Chong and Ren Channels; Kidney Deficiency and Damaged Qi and Blood; Liver Qi Stagnation, Dysfunction of Chong and Ren Channels; Damaging Yin); Liver Overacting on Spleen (Psychogenic Anorexia); Qi and Blood Deficiency, Empty Blood Sea, and Scanty Source; Polycystic Ovarian; Yang Deficiency and Phlegm Damp; Warm Kidney Yang, strengthen Spleen, eliminate phlegm, and regu late; Phlegm-Damp Transform into Heat. Treatment follows the pattern a patient presents with, not the Western diagnosis alone.

When to get help: Do a pregnancy test and see a doctor if your periods stop for three months, or have not started by 15. Avoid blood-moving herbs that promote menstruation until pregnancy has been ruled out.