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Amenorrhoea and female fertility: what it means not to have a period and how it can affect pregnancy
You haven’t had a period for a while and are starting to wonder what this means for your health and your chances of becoming a mother. Are you ovulating? Could it be due to stress, training, elite sport or a hormonal imbalance? Is it possible to get pregnant with amenorrhoea?
At Vida Fertility, we start by listening to your story and understanding what is happening. In this article, Dr Marta Zermiani, gynaecologist and fertility specialist at Vida Fertility, explains what amenorrhoea is, why your period might stop, what the consequences are, and what options can be considered if you wish to become a mother.
- What is amenorrhoea?
- What causes amenorrhoea and how does it affect fertility?
- Consequences of amenorrhoea: is it dangerous?
- How is the cause of amenorrhoea diagnosed?
- Amenorrhoea and sport
- When should I consult a specialist if I miss a period?
- Frequently asked questions about amenorrhoea and fertility
- Our fertility treatments
- The best fertility clinics in Spain
What is amenorrhoea?
Amenorrhoea is the absence of menstruation. It is a symptom that can have various causes; it is not a diagnosis that, on its own, explains what is happening with your fertility.
To guide the investigation, a distinction is made between primary and secondary amenorrhoea.
Primary amenorrhoea
This refers to the absence of the first menstrual period. It is advisable to have this investigated if menstruation has not begun by the age of 15, or earlier if other signs of pubertal development are absent.
The assessment allows for the investigation of hormonal causes and possible abnormalities in the development of the reproductive system.
Secondary amenorrhoea
This occurs when a woman who was already menstruating stops doing so. It is recommended to have this investigated after more than three months without a period if cycles were regular, or six months if they were already irregular.
These are assessment criteria, not timeframes you should wait for if you are trying to conceive or have other symptoms.
What causes amenorrhoea and how does it affect fertility?
The absence of menstruation can occur during pregnancy, breastfeeding or after the menopause. Some hormonal contraceptives can also reduce or stop bleeding. If there is a possibility of pregnancy, the first step is to take a test, even if your cycles are irregular.
Outside these contexts, amenorrhoea may be linked to various conditions:
· Thyroid disorders or elevated prolactin: these can interfere with the hormonal signals that regulate the cycle and ovulation.
· Polycystic ovary syndrome: this can lead to infrequent ovulation or a complete absence of ovulation.
· Functional hypothalamic amenorrhoea: factors such as an energy deficit, weight loss, intense exercise or stress can disrupt hormonal regulation and halt ovulation.
· Primary ovarian insufficiency: this can reduce ovarian activity and make it difficult to conceive.
· Certain medicines or anatomical abnormalities: these can alter the cycle or prevent menstrual bleeding, although in some cases ovarian function remains intact.
The impact of amenorrhoea on fertility depends on its cause. If ovulation does not occur, spontaneous conception cannot take place during that time. However, the absence of a period does not in itself indicate a permanent loss of fertility.
Age, medical history, symptoms and tests help to understand what is happening. It is not advisable to attribute the absence of menstruation to stress or exercise without ruling out other causes.
Consequences of amenorrhoea: is it dangerous?
The consequences depend on the underlying cause. Not every instance of absent menstruation carries the same risks, so follow-up care must be tailored to each woman.
Difficulty in becoming pregnant
As long as ovulation is not taking place, it is not possible to conceive naturally. However, the absence of menstruation does not necessarily mean that you have stopped ovulating permanently or that you will be unable to become pregnant in the future.
Bone health and symptoms associated with low oestrogen levels
If the absence of menstruation is accompanied by low oestrogen levels over a prolonged period, bone health may be affected. Hot flushes or vaginal dryness may also occur, although not all women experience these symptoms.
If you notice these symptoms, it is important to seek medical advice to assess their cause.
Changes in the endometrium
When a lack of ovulation persists over time, as can happen in polycystic ovary syndrome, the endometrium (the lining of the womb) may be stimulated by oestrogen without the usual regulating effect of progesterone.
This can cause it to thicken excessively, so medical monitoring is required. This mechanism differs from that of amenorrhoea associated with low oestrogen levels.
How is the cause of amenorrhoea diagnosed?
The consultation begins by reviewing the date of the last period, previous cycles, the possibility of pregnancy, any medication and other changes in health.
Depending on the case, the following may be recommended:
- A pregnancy test.
- Blood tests to check thyroid function, prolactin and hormones related to ovarian function.
- An ultrasound scan to assess the ovaries and uterus.
- Further investigations.
Not all women require the same tests. The AMH test can provide information in specific situations, but it does not, on its own, explain the cause of amenorrhoea or predict pregnancy.
Amenorrhoea and sport
Are you wondering whether sport and fertility are compatible? Some female athletes experience impaired fertility because the energy they have left after training is insufficient to adequately sustain other bodily functions. This imbalance can disrupt the hormonal signals that regulate the cycle.
Assessing possible hypothalamic amenorrhoea requires ruling out other causes. The approach may include adjustments to diet, training load and psychological support.
Contraceptives are not recommended solely to restore menstruation or improve bone health in this situation: they may mask whether the spontaneous cycle has returned.
When should I consult a specialist if I miss a period?
Seek advice if the absence persists, your cycles change persistently, or symptoms such as significant weight changes, excessive hair growth or fatigue appear.
If you’re trying to conceive and your period hasn’t come, book a medical assessment, without waiting for the usual timeframe for trying to conceive with regular cycles.
At Vida Fertility, we want to help you understand what’s happening and what options you have. During an initial consultation, we can review your menstrual history, any tests you’ve already had, and your plans for motherhood.
Frequently asked questions about amenorrhoea and fertility
Dr Marta Zermiani answers:
What are the chances of getting pregnant if I have amenorrhoea?
Yes, it is possible, but it depends on the cause. Some women experience occasional ovulation or resume ovulation before their period returns. For this reason, amenorrhoea should not be used as a method of contraception.
Is it possible to ovulate if I have amenorrhoea?
There may be occasional ovulation or a return to ovulation before the next period. The absence of bleeding does not allow us to predict with certainty what will happen in the days that follow.
I haven’t had a period for a year: can I get pregnant?
It depends on the reason for the absence. A year without a period requires medical assessment; it does not, on its own, mean that you have reached the menopause or are infertile. If you are hoping to become pregnant, a fertility specialist should investigate the cause and your chances of conceiving.
What treatments are available for amenorrhoea if I want to become pregnant?
The treatment is chosen based on the diagnosis and your reproductive goals. It may involve correcting a hormonal imbalance, addressing an energy imbalance or treating an anatomical problem where appropriate.
In certain situations, ovulation induction using medication and medical monitoring is considered.
Assisted reproduction may be an option depending on the cause and the overall fertility assessment, but having amenorrhoea does not automatically mean you need IVF.
Is the absence of menstruation a cause of infertility?
The absence of a period does not automatically mean infertility, but it can be a sign of a condition that makes it difficult to conceive. When it is due to a lack of ovulation, spontaneous conception cannot occur until ovulation is restored. In other cases, the cause may be hormonal or anatomical. Identifying the cause of amenorrhoea allows us to assess how it affects your fertility and what options you have for trying to conceive.
Does amenorrhoea caused by contraceptives affect future fertility?
The absence of periods whilst on certain contraceptive treatments does not indicate any damage to fertility. If your period does not return after stopping the contraceptive, it is advisable to assess the type of contraceptive and other possible causes. Not all contraceptives result in the same pattern of recovery.
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