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Dr. Chrysoula I. Liakou MD, PhD
- Treated online: Yes, for assessment and a treatment plan. The history is taken by video, a pregnancy test and blood tests arranged, and causes such as PCOS or thyroid problems treated or referred; a positive test with one-sided pain, or a severe headache, means in-person care.
- What it is: no period for 3 months or more (secondary amenorrhoea, affecting about 3 to 4 in 100 women at any time), or no first period by 15 (primary); after pregnancy, the commonest causes are hormonal contraception, PCOS, low weight or heavy exercise, stress and thyroid disease.
- Test order: a pregnancy test first whatever you expect, then thyroid function, prolactin, FSH, LH and oestradiol, and where the picture fits, testosterone for PCOS; the results usually name the cause without any scan.
- Before 40: periods stopping before about 40 is not normal ageing: premature ovarian insufficiency affects about 1 in 100 women under 40 and needs assessment, because the low oestrogen that comes with it also affects bone and heart health.
- Expected amenorrhoea: the hormonal coil, implant, injection and continuous pill use can stop periods on purpose, as can breastfeeding; that is expected and harmless, and periods return within months of stopping, up to a year after the injection.
- Emergency: call 112 for a positive pregnancy test with severe one-sided pelvic pain, shoulder-tip pain or fainting, which can be an ectopic pregnancy, or for a sudden severe headache with vision changes.
Absent periods are rarely an emergency, but arrange prompt in-person care if you have a positive pregnancy test with severe one-sided pelvic pain or shoulder-tip pain (possible ectopic pregnancy), sudden severe headache with vision changes or milky nipple discharge (which can point to a pituitary problem), or if periods have stopped alongside very low body weight or an eating disorder that needs urgent support. Otherwise, an online assessment is a good place to start.
Can an online doctor help with absent periods (amenorrhoea)?
Yes, for the assessment. Amenorrhoea means no menstrual periods, either never starting by around age 15 (primary) or stopping for three months or more in someone who was regular (secondary). A doctor can take a full history by video, arrange a pregnancy test and the right blood tests, and explain the likely cause. Some causes are then treated directly; others need a specialist.
The doctors on Mobi Doctor follow that order on purpose. Pregnancy is the single most common reason regular periods stop, so it is ruled in or out first, before anything else is assumed. Only then does the work-up move on to hormones, thyroid, weight and the other causes below.
How an online consultation helps with amenorrhoea
- A pregnancy test first, stated plainly: the doctor does not tiptoe around it. Whatever your circumstances, a pregnancy test comes before any hormonal explanation, because it changes everything that follows and is easy to check with a home or pharmacy test.
- A structured causes work-up: polycystic ovary syndrome, thyroid problems, low weight or heavy exercise, raised prolactin and early menopause each leave clues in your history. The doctor sorts through them rather than guessing.
- The right blood tests, in the right order: instead of a scattergun panel, the doctor requests the tests that actually change the plan, and explains what each result would mean.
- Honest referral when it fits: primary amenorrhoea, a suspected pituitary cause, early menopause and fertility questions are steered to gynaecology or endocrinology, with a clear reason why.
What is amenorrhoea?
Amenorrhoea is the medical word for absent menstrual periods. Doctors divide it into two kinds, and the split matters because it changes the work-up.
Primary amenorrhoea
Periods have never started. This is usually assessed if there is no period by around age 15 with otherwise normal development, or by around 13 with no signs of puberty at all. The causes range from a simple constitutional delay to hormonal, genetic or anatomical reasons, and it almost always warrants specialist gynaecology or endocrinology assessment rather than treatment at a distance.
Secondary amenorrhoea
Periods started but have since stopped, defined as no periods for three months in someone with previously regular cycles, or six months if cycles were irregular.[1] This is the more common scenario in adults, and pregnancy heads the list of causes. Missing the occasional period, or slightly irregular cycles, is a slightly different question, but a run of missed periods is worth assessing.
What causes amenorrhoea?
Periods depend on a chain of signals from the brain to the ovaries and womb, so anything that interrupts that chain can stop them. The common causes group into a handful of patterns.
Pregnancy, breastfeeding and the menopause transition
Pregnancy is by far the most frequent reason regular periods stop, which is exactly why it is tested first.[1] Breastfeeding suppresses periods for a while after childbirth, and in the years around the menopause, cycles naturally become irregular and eventually cease. Periods stopping before around age 40, though, is not normal ageing and points to premature ovarian insufficiency, which needs assessment.[4]
Polycystic ovary syndrome (PCOS)
PCOS is one of the most common hormonal reasons for infrequent or absent periods in younger women. It often comes with acne, excess facial or body hair, and weight that is hard to shift, and it is diagnosed on a combination of features rather than a single test.[2] Recognising it matters because managing the hormonal driver, and protecting the womb lining when periods are very infrequent, becomes part of the plan.
Thyroid problems and raised prolactin
An underactive or overactive thyroid can disrupt periods, and both are simple to check on a blood test. A raised level of the hormone prolactin can also switch periods off; it may be triggered by certain medicines or, less commonly, by a small benign pituitary growth, and milky nipple discharge or persistent headaches are clues worth mentioning.[1]
Weight, exercise and stress
The brain can quietly pause the cycle when the body reads its circumstances as unsafe for pregnancy: very low body weight, rapid weight loss, heavy endurance training or sustained stress can all do it, a pattern doctors call hypothalamic amenorrhoea. It is common in athletes and in restrictive eating, and it is important precisely because absent periods from low oestrogen also affect bone strength over time. This one is treated by addressing the underlying balance, sometimes with specialist support, not by forcing a bleed.
Contraception and medicines
Several forms of contraception reduce or stop periods on purpose, including the hormonal coil, the implant, the injection and continuous use of the pill, and this is expected and harmless. Some other medicines affect the cycle too. Part of the consultation is separating a medicine-related pause, which needs no alarm, from a cause that does.
Is your amenorrhoea suitable for online assessment?
Usually yes, as a starting point. A video consultation is well suited to taking the history, arranging a pregnancy test and initial bloods, and explaining the likely cause. Where the picture points to primary amenorrhoea, a pituitary cause, early menopause or fertility investigation, the honest next step is a referral. This is the framework the doctors use, aligned with the cited guidance.[1]
Swipe sideways to compare →
| Presentation | Likely first step | Suitable for online care? | When referral or in-person care is needed |
|---|---|---|---|
| Periods stopped, pregnancy possible | Pregnancy test first, then review[1] | Yes, for assessment | Positive test needs pregnancy care; pain or bleeding needs urgent review |
| Secondary amenorrhoea, negative test, features of PCOS | Blood tests and lifestyle advice; cycle protection where needed[2] | Usually yes | Fertility plans, complex or unclear results |
| Low weight, heavy exercise or disordered eating | Assessment, bone-health advice, tailored support | Partly | Specialist or eating-disorder services when needed |
| Primary amenorrhoea (no period by mid-teens) | History and initial bloods, then referral | Initial assessment only | Gynaecology or endocrinology, routinely |
| Milky discharge, headaches or vision changes | Prompt assessment and prolactin testing | No | Urgent in-person and specialist review |
Not sure which row is you? A doctor can tell you in one consultation.
See available times →What the doctor checks in an online amenorrhoea consultation
The consultation is structured to find the cause efficiently, not to reach a verdict from a single symptom. The doctor will typically ask about:
- Your cycle story: when periods started, what was normal for you, when they stopped, and whether they were regular or erratic before that.
- Pregnancy possibility: directly and without embarrassment, because it is tested first regardless of what you expect the answer to be.
- Weight, eating and exercise: recent weight change, training load and any restrictive eating, which point toward a hypothalamic cause.
- Androgen features: acne, excess hair growth and scalp hair thinning, which raise the question of PCOS.[2]
- Prolactin and pituitary clues: milky nipple discharge, persistent headaches or changes in vision.
- Menopause clues: hot flushes, night sweats and vaginal dryness, especially before age 40.
- Medicines and contraception: anything hormonal, plus other drugs that can affect the cycle.
- Family history: the age relatives reached menopause, and any thyroid or hormonal conditions.
From that history the doctor decides which blood tests genuinely change the plan, commonly a pregnancy test, thyroid function, prolactin, and hormones such as FSH, LH and oestradiol, with others added when the story calls for them.[1] You take these at a local laboratory, and the doctor reviews the results with you.
When amenorrhoea is assessed online, and when you need in-person care
Assessed and treated online: taking the history and arranging a pregnancy test and initial bloods; explaining a likely PCOS, thyroid, weight-related or contraception-related cause; lifestyle advice and, where appropriate, discussing options such as a combined contraceptive pill to regulate cycles or protect the womb lining; and reviewing medicines that may be responsible.
In-person care: primary amenorrhoea, which needs specialist gynaecology or endocrinology; a suspected raised-prolactin or pituitary cause; premature ovarian insufficiency (periods stopping before around 40), which needs hormone assessment and often hormone replacement guidance; disordered eating or very low weight, where specialist and, where relevant, mental-health support belongs; and fertility investigation when you are trying to conceive.[3] A positive pregnancy test moves you into pregnancy care rather than this pathway. Amenorrhoea sits within the wider sexual and reproductive health assessments, and where symptoms point elsewhere, such as vaginal thrush or a suspected urinary tract infection, the doctor steers you to the right assessment instead.
Why finding the cause matters
Amenorrhoea is worth taking seriously not because a missed bleed is dangerous in itself, but because of what it can signal. Prolonged low oestrogen, whether from a hypothalamic cause or early menopause, gradually weakens bone and raises the long-term risk of osteoporosis, which is one reason low-weight and athletic amenorrhoea are not simply left alone.[1][5] In PCOS, very infrequent periods mean the womb lining is not shed regularly, and over years that can matter for the lining's health, so protecting it becomes part of care.[2] And when absent periods are the visible edge of an eating disorder, a thyroid problem or a pituitary growth, treating the cause helps far more than the periods. Finding the reason is the whole point of the assessment.
Treatment options for amenorrhoea (absent periods)
What you can do yourself
Because amenorrhoea is a sign rather than a disease, self-care depends on the cause. Where low body weight, rapid weight loss or heavy training is the driver, restoring energy balance is the single most effective step, and periods often return once the body reads its circumstances as stable again; support from a professional makes this easier and safer. Reducing sustained stress helps for the same reasons. If you have PCOS, even modest changes to activity and eating can improve cycle regularity, and it is worth knowing this is about hormones and metabolism, not willpower. What no one should do is ignore periods that have stopped for months in the hope they simply restart, because the cause is worth knowing either way.
Prescription treatment after your consultation
A prescription is never issued without a consultation, and for amenorrhoea it follows the cause rather than the symptom. An underactive thyroid is corrected with thyroid hormone, which often restores periods. In PCOS, a combined hormonal contraceptive can regulate bleeding and protect the womb lining when cycles are very infrequent, chosen after the usual suitability checks.[2] A raised prolactin from a pituitary cause is treated with specific medicines under specialist guidance, and premature ovarian insufficiency is usually managed with hormone replacement to protect bones and manage symptoms, again with specialist input.[5] There is no single tablet that treats amenorrhoea, and any service implying otherwise is skipping the part that matters, which is finding out why periods stopped.
When to get in-person care
Absent periods are rarely an emergency, but some situations need urgent attention. If you have a positive pregnancy test with severe one-sided lower abdominal pain, shoulder-tip pain, dizziness or faintness, this can indicate an ectopic pregnancy, and you should seek emergency care or call 112 without delay. A sudden severe headache with vision loss also needs emergency assessment. Seek prompt, though not emergency, care for new milky nipple discharge with headaches, or if absent periods come with an eating disorder that feels out of control, where timely support genuinely helps.
How Mobi Doctor works
- Book a time that suits you: open daily 7am–11pm CET. You can see a doctor over video, usually within 15 minutes. No subscription, exact price up front.
- Speak to a licensed doctor about amenorrhoea (absent periods): a private video call from anywhere in Europe; take a pregnancy test beforehand if you can, it shortens the path.
- Get a clear plan: the tests that matter, an explanation of the likely cause, and treatment or referral as needed, or a full refund.
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Frequently asked questions about amenorrhoea (absent periods)
What is amenorrhoea, and what causes it?
Amenorrhoea is the absence of periods: for 3 months or more in someone who had them (secondary), or no first period by 15 (primary). Pregnancy is the commonest cause of secondary amenorrhoea; the others are hormonal contraception, breastfeeding, polycystic ovary syndrome, low body weight, rapid weight loss or heavy exercise, stress, an under- or overactive thyroid, raised prolactin from the pituitary, premature ovarian insufficiency, and the approach of the menopause.
Can an online doctor find out why my periods have stopped?
Often, yes: a doctor can take a full history by video, arrange a pregnancy test and the right blood tests at a laboratory near you, and explain the likely cause of your amenorrhoea, whether that is pregnancy, PCOS, a thyroid problem, low weight or something else, then start treatment or refer you. A pituitary problem or premature ovarian insufficiency needs a specialist, and the consultation gets you there with the tests already done.
Do I really need a pregnancy test if I do not think I am pregnant?
Yes: pregnancy is the most common reason regular periods stop, and a test is quick, cheap and reliable, so it is checked first whatever you expect the result to be. Ruling it in or out changes everything that follows, from which blood tests make sense to which treatments for amenorrhoea are safe, and taking a home test before the video call saves a step.
What are the symptoms that come with amenorrhoea, and what do they mean?
The symptoms alongside missing periods point to the cause: nausea, breast tenderness and tiredness suggest pregnancy; acne, excess hair and weight gain suggest PCOS; hot flushes, night sweats and vaginal dryness suggest ovarian insufficiency or menopause; milky nipple discharge or headaches suggest raised prolactin; feeling cold, tired and gaining weight suggests an underactive thyroid; and weight loss or heavy training suggests hypothalamic amenorrhoea.
Are absent periods a sign of infertility?
Not on their own: amenorrhoea means you may not be ovulating regularly at the moment, which can make conceiving harder while it lasts, but many causes are treatable and ovulation returns once they are addressed, for example restoring weight, treating a thyroid problem or managing PCOS. If you are trying to conceive and periods have been absent for three months, early assessment shortens the time to a plan.
Could stress or exercise really stop my periods?
Yes: very low body weight, rapid weight loss, heavy endurance training and sustained stress can all pause the cycle by switching off the signals from the brain to the ovaries, a pattern called hypothalamic amenorrhoea. It matters because the low oestrogen that comes with it also weakens bone over time, so treatment means restoring energy balance, with support from a dietitian and, for athletes, a review of training load.
What blood tests might the doctor arrange for amenorrhoea?
Commonly a pregnancy test, thyroid function and prolactin, along with the reproductive hormones FSH, LH and oestradiol, and testosterone where PCOS is possible, with others added when your history calls for them. The doctor chooses the tests that change the plan rather than a scattergun panel, arranges them at a laboratory near you, and reviews the results at a follow-up where the cause of the amenorrhoea is usually clear.
How long without a period is too long?
Missing one period happens to most women at some point and needs only a pregnancy test. Amenorrhoea of three months or more, whatever your age, or six months in someone whose cycles were already irregular, always deserves assessment, as does no first period by 15, and periods stopping before 40 alongside hot flushes. Most causes are found within one round of blood tests.
Can contraception stop my periods, and is that harmful?
Yes, and it is expected: the hormonal coil, the implant, the injection and continuous use of the combined or progestogen-only pill can all stop periods, and that is harmless, because the womb lining simply stays thin rather than building up. Periods usually return within one to three months of stopping, and up to a year after the last injection; amenorrhoea that persists beyond that is assessed as usual.
What can I do myself about absent periods?
Take a pregnancy test, note when your last period was and any pattern before it, keep a record of weight, exercise, stress and sleep, check whether a contraceptive or a new medicine such as an antipsychotic explains the amenorrhoea, eat enough for your activity level, and bring that information to the consultation; it narrows the cause before any test is done.
Can amenorrhoea be prevented?
Amenorrhoea from pregnancy, contraception or the menopause is not something to prevent. The preventable kind is hypothalamic: keeping body weight and energy intake matched to training, avoiding crash diets, managing stress and sleep, and treating an eating disorder early protect both the cycle and the bones. Thyroid and PCOS-related amenorrhoea are managed rather than prevented.
Is amenorrhoea treated differently in teenagers or in women over 40?
In teenagers, no first period by 15 or periods stopping soon after starting is assessed for growth, weight and hormonal causes; Mobi Doctor sees adults only, so a teenager is seen in person. In women over 40, amenorrhoea with hot flushes is usually perimenopause, confirmed by the pattern rather than blood tests; under 40 the same picture is premature ovarian insufficiency, treated with hormone replacement until the usual age of menopause.
- Amenorrhoea: clinical knowledge summary, NICE, National Institute for Health and Care Excellence, reviewed 2024.
- International evidence-based guideline for the assessment and management of polycystic ovary syndrome, ESHRE, European Society of Human Reproduction and Embryology, 2023.
- Infertility fact sheet, World Health Organization (WHO), 2024.
- Menopause: identification and management (NG23), NICE, National Institute for Health and Care Excellence, 2015, updated 2024.
- Guideline on premature ovarian insufficiency, ESHRE, European Society of Human Reproduction and Embryology, 2024.
- Missed or late periods, NHS, National Health Service (UK), reviewed June 2026.
This page is for information only and is not a substitute for a medical consultation. Guideline links are provided for transparency; treatment decisions are made with your doctor.
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