Amenorrhoea
Also known as: amenorrhoea, amenorrhea, primary amenorrhoea, secondary amenorrhoea, functional hypothalamic amenorrhoea, hypothalamic amenorrhoea, absence of menstruation, absent menstrual periods
Amenorrhoea means the absence of menstrual periods. Primary amenorrhoea generally describes menstruation that has not commenced by the expected age or developmental stage, while secondary amenorrhoea describes the cessation of previously established menstrual periods. Amenorrhoea is a clinical sign rather than a single disease. Pregnancy is the most common cause of secondary amenorrhoea and should generally be excluded first whenever biologically possible. Other causes include breastfeeding, menopause, functional hypothalamic suppression associated with low energy availability, eating disorders, substantial weight change, excessive exercise or psychological stress, polycystic ovary syndrome, thyroid disease, hyperprolactinaemia, primary ovarian insufficiency, pituitary or hypothalamic disease, congenital reproductive-tract differences, uterine scarring and medication effects. Evaluation may include menstrual and sexual history, pregnancy testing, nutritional and exercise assessment, examination, hormone testing and pelvic imaging, with additional investigations directed by the suspected cause. Management targets the underlying condition and may involve nutrition rehabilitation, exercise modification, psychological care, hormonal treatment, fertility management, thyroid or prolactin treatment, or specialist surgery. Prolonged hypo-oestrogenism can adversely affect bone density, cardiovascular health, sexual function and fertility. TCM differentiation commonly includes Kidney essence deficiency, Kidney Yang deficiency, Liver and Kidney Yin deficiency, Spleen Qi and Blood deficiency, Liver Qi stagnation, Phlegm-Damp obstruction, Cold congealing with Blood stasis or Qi stagnation and Blood stasis. Acupuncture and Chinese herbal medicine may be considered only as adjunctive care after pregnancy and significant endocrine, nutritional, anatomical and systemic causes have been appropriately assessed. [1][2][3][4][5][6][7]
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Lifestyle & Diet
- •Take a pregnancy test when pregnancy is biologically possible and a period is unexpectedly absent.
- •Seek medical assessment for persistent amenorrhoea rather than waiting indefinitely for menstruation to return.
- •Track menstrual dates, bleeding, pregnancy tests, weight changes, exercise, medicines and associated symptoms.
- •Provide clinicians with a complete list of prescription medicines, contraceptives, hormones, supplements and herbal products.
- •Do not stop hormonal contraception or prescribed endocrine treatment without discussing it with the prescriber.
- •Understand that some hormonal contraceptives can reduce or stop withdrawal bleeding without causing illness.
- •Breastfeeding can delay ovulation and menstruation, but pregnancy can occur before the first postpartum period.
- •The lactational amenorrhoea method is reliable only when all required criteria are met and only during the limited postpartum period for which it is recommended.
- •Maintain adequate energy and nutrient intake relative to exercise and daily activity.
- •Avoid crash diets, prolonged fasting and excessive exercise intended to restore hormonal balance through further weight loss.
- •Functional hypothalamic amenorrhoea often requires increased energy availability, reduced training load and psychological or nutritional support.
- •A person can have low energy availability at any body size.
- •Seek specialised eating-disorder care for restrictive eating, purging, intense fear of weight gain or compulsive exercise.
- •Ensure adequate calcium, vitamin D, protein and overall nutrition according to individual clinical advice.
- •Discuss bone-density assessment when amenorrhoea and low oestrogen have been prolonged or when stress fractures occur.
- •Use weight-bearing and resistance exercise only at a medically appropriate level, particularly when undernourished or recovering from stress fracture.
- •Discuss fertility goals early because treatment differs when pregnancy is desired.
- •Amenorrhoea does not reliably prevent pregnancy unless a validated contraceptive method is being used correctly.
- •Manage PCOS-related metabolic risks with evidence-based care rather than focusing only on restoring monthly bleeding.
- •Seek psychological support when infertility, body-image concerns, eating difficulties or menstrual changes affect wellbeing.
- •Do not use unregulated fertility supplements or hormone products.
- •Report new headaches, visual changes, nipple discharge, rapid androgenic change, pelvic pain or menopausal symptoms to a clinician.
- •Attend recommended follow-up even if bleeding resumes because the underlying cause may still require management.
Cautions & Contraindications
- •Do not use acupuncture or herbal medicine to induce menstruation before pregnancy has been excluded.
- •Do not delay emergency care for possible ectopic pregnancy.
- •Do not treat primary amenorrhoea without appropriate medical assessment.
- •Do not attribute amenorrhoea solely to stress, Kidney deficiency, Cold, Blood deficiency or Phlegm.
- •Do not advise further weight loss, fasting or increased exercise in suspected functional hypothalamic amenorrhoea or low energy availability.
- •Do not advise a person with an eating disorder to manage amenorrhoea through complementary treatment alone.
- •Do not claim that a withdrawal bleed or isolated menstrual period confirms restored fertility or ovulation.
- •Do not claim that acupuncture or herbs cure PCOS, primary ovarian insufficiency, pituitary disease or anatomical reproductive-tract disorders.
- •Do not advise discontinuation of contraception, hormone replacement, thyroid medication, dopamine agonists or fertility medicines without the prescriber.
- •Avoid lower-abdominal acupuncture and strongly Blood-moving herbs in possible or confirmed pregnancy.
- •Avoid oral herbs when severe vomiting, medical instability or impaired swallowing is present.
- •Fù Zǐ must be correctly processed and professionally prescribed because of cardiotoxic and neurotoxic risk.
- •Bàn Xià must be correctly processed because the raw herb is toxic.
- •Blood-moving herbs including Táo Rén, Hóng Huā, Dān Shēn, Dāng Guī, Chuān Xiōng, Niú Xī and Yán Hú Suǒ require pregnancy, anticoagulant and bleeding-risk review.
- •Hé Shǒu Wū has recognised hepatotoxicity risk.
- •Gān Cǎo may affect blood pressure, potassium and medicine metabolism.
- •Mù Tōng must be botanically verified and free of aristolochic acid.
- •Avoid animal-derived, endangered-species, contaminated, adulterated or incorrectly identified herbal ingredients.
- •Screen all herbal prescriptions for pregnancy, breastfeeding, fertility treatment, liver or kidney disease, allergies and medicine interactions.
- •Do not interpret worsening pain, fainting, severe weakness or psychiatric deterioration as a healing response.
When to reassess or seek care again
- •Reassess at 4-6 weeks: confirm pregnancy status if any risk, review menstrual diary, weight, energy intake, exercise load and mood.
- •At 3 months: if periods have not resumed and medical assessment is incomplete, refer to GP, gynaecology or endocrinology; do not continue adjunctive treatment as sole care.
- •Escalate immediately for new red-flag symptoms (severe headache, visual change, galactorrhoea, virilisation, pelvic pain, syncope, suicidal ideation).
- •Annual review of bone health, cardiovascular risk and fertility goals when hypo-oestrogenism persists.
Frequently Asked Questions
What is amenorrhoea?+
Amenorrhoea means the absence of menstrual periods. It can be primary, when menstruation has not begun by the expected developmental stage, or secondary, when established periods stop [8].
What is the first test usually considered for secondary amenorrhoea?+
Pregnancy testing is generally the first investigation whenever pregnancy is biologically possible [8].
What commonly causes amenorrhoea?+
Causes include pregnancy, breastfeeding, menopause, low energy availability, eating disorders, excessive exercise, PCOS, thyroid disease, elevated prolactin, primary ovarian insufficiency, pituitary disease, reproductive-tract differences and medication effects [8].
When should primary amenorrhoea be assessed?+
Medical assessment is generally recommended when menstruation has not begun by age 15 or within approximately 3 years of breast development, or when pubertal development is absent or atypical [8].
Why is prolonged amenorrhoea important?+
When caused by low oestrogen, prolonged amenorrhoea can affect bone density, fertility, sexual function and broader health [8].
What is functional hypothalamic amenorrhoea?+
It is suppression of the reproductive hormone system associated with low energy availability, undernutrition, substantial exercise, weight change, psychological stress or a combination of these factors [8].
Can someone become pregnant while amenorrhoeic?+
Yes. Ovulation may occur before menstruation returns, so absent periods do not reliably prevent pregnancy [8].
What TCM patterns may be considered?+
Traditional patterns may include Kidney essence deficiency, Kidney Yang deficiency, Liver-Kidney Yin deficiency, Qi-Blood deficiency, Liver Qi stagnation, Phlegm-Damp obstruction, Cold with Blood stasis and Qi stagnation with Blood stasis [8].
Can acupuncture restore periods?+
Evidence is insufficient to guarantee restoration of menstruation. Acupuncture may be considered adjunctively while the underlying cause is medically assessed and treated [8].
Can herbs be taken before pregnancy is excluded?+
No strongly menstrual-regulating or Blood-moving formula should be used before pregnancy has been reasonably excluded because some herbs may be inappropriate during pregnancy [8].
When is amenorrhoea an emergency?+
Emergency assessment is required for possible pregnancy with severe pain, bleeding or collapse, severe malnutrition or cardiac symptoms, major neurological symptoms, severe psychiatric risk or acute systemic illness [8].
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Sources & Further Reading
Clinical guidance, red flags and safety notes on this page draw on the following current sources alongside the classical references above.
- American College of Obstetricians and Gynecologists · 2026
Clinical overview of primary and secondary amenorrhoea, common causes, assessment and management.
- American College of Obstetricians and Gynecologists · 2026
Guidance on expected menarche, pregnancy testing and assessment when menstruation does not begin.
- American College of Obstetricians and Gynecologists · 2018
Assessment of oligomenorrhoea and amenorrhoea associated with eating disorders and low energy availability.
- National Health Service · 2026
Overview of pregnancy, stress, exercise, weight change, PCOS, thyroid disease and other causes of missed periods.
- Healthdirect Australia · 2026
Australian information on menstruation and common menstrual disorders, including amenorrhoea.
- Healthdirect Australia · 2026
Australian guidance on the limited criteria under which breastfeeding-related amenorrhoea can function as contraception.
- Cleveland Clinic · 2023
Clinical explanation of primary and secondary amenorrhoea, causes, diagnosis and treatment.
- World Health Organization · 2008
Standardised nomenclature and anatomical-location methodology for acupuncture points.
- World Health Organization · 2020
International benchmarks for safe acupuncture education and clinical practice.
Educational reference for licensed practitioners. Not a substitute for individual clinical assessment. Refer to conventional care for any red-flag or undiagnosed presentation.