Q & A Library

Print this page | Sign up for free e-bulletins
 | Bookmark This Page

Missing Menstruation?

I am a 20 year old female, physically active, and at a healthy weight. I have never menstruated and have been found to have extremely low estrogen levels. I have been on Premarin for 3 or 4 months now and am concerned about future health risks associated with taking it long term. Is there a safer alternative?

Answer (Published 11/19/2009)

Never having menstruated after the age of 16 despite having experienced all the other physical changes that occur during puberty is considered “primary amenorrhea.” The rate of this disorder in the United States is less than one percent. Another type of amenorrhea, “secondary” (which means menstruation started but then stopped) is more common – the rate is approximately four percent.

Related Weil Products
Dr. Weil on Healthy Aging for Women's Health Issues - If you are going through menopause, a support group can be helpful. The Dr. Weil on Healthy Aging online guide has a vibrant, active community of supportive members, and a dedicated moderator to help guide you along. Start your 14-day free trial now!

There are many reasons for primary amenorrhea including hormonal problems involving the pituitary gland or the hypothalamus, both of which set in motion the other hormones that regulate the menstrual cycle. Thyroid problems can also be to blame, and in some cases, birth defects, genetic anomalies, or underlying systemic diseases are at fault. Obesity and malnutrition can also cause primary amenorrhea, but none of these problems seems relevant in your case since you say that you’re otherwise healthy and of normal weight.

Your wisest course at this point would be to consult an endocrinologist with a special interest in amenorrhea. You need a thorough gynecological and endocrinological workup to determine why you haven’t begun menstruating. What you’re experiencing isn’t normal, and I'm not sure that replacing low estrogen by taking Premarin is the best course to follow. Once the cause of amenorrhea is identified, treatment can be targeted to the problem and usually is successful.

Andrew Weil, M.D.

Creative Commons License Some Rights Reserved Creative Commons Copyright Notice
A portion of the original material created by Weil Lifestyle on (specifically, all question and answer-type articles in the Dr. Weil Q&A Library) is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.

The Weil Vitamin Advisor
Get your FREE personalized vitamin recommendation & supplement plan today!

Dr. Weil on Healthy Aging
Your Online Guide to the Anti-Inflammatory Diet. Start eating for your health - begin your free trial now.

Dr. Weil's Spontaneous Happiness
Achieve emotional well-being in just eight weeks! Start your 10-day free trial now!

Vitamin Library
Supplement your knowledge with Dr. Weil's essential vitamin facts. Learn why they are necessary and more.

Dr. Weil's Optimum Health Plan
Your 8-week plan to wellness.
Begin your journey today!

Dr. Weil's Head-to-Toe Wellness Guide
Your guide to natural health.
Use the Wellness Guide today!

Dr. Weil's Anti-Inflammatory Diet
Food Pyramid

Our interactive tool can help improve overall health through diet.

Condition Care Guide
Learn about health conditions from acne to vertigo, and Dr. Weil's view of the best treatment options for each.

Healthy Recipes
Discover a treasure trove of healthy, healing foods and creative, delicious ways to prepare them.

Q&A Library
Over 2,000 questions from you and their corresponding answers from Dr. Weil.

Copyright © 2015 Weil Lifestyle
Information on this web site is provided for informational purposes only and is not intended as a substitute for the advice provided by your physician or other healthcare professional. You should not use the information on this web site for diagnosing or treating a health problem or disease, or prescribing any medication or other treatment.

Ad Choice
Advertising Notice

This Site and third parties who place advertisements on this Site may collect and use information about your visits to this Site and other websites in order to provide advertisements about goods and services of interest to you. If you would like to obtain more information about these advertising practices and to make choices about online behavioral advertising, please click here