In practice, nomadic hunter-gatherers space their children about four years apart by means of lactational amenorrhea, sexual abstinence, infanticide, and abortion.
An early symptom is agalactorrhea, whereas late symptoms include amenorrhea, low blood pressure, low blood sodium, low blood glucose levels, as well as fatigue and muscle loss.
Primary amenorrhea is also suspected when a female hasn't had menarche by age 13 and doesn't show signs of puberty, which include developing secondary sexual characteristics like breasts.
Later symptoms include amenorrhea, an absence of a normal menstrual cycle, even after a period of lactation, which is due to a lack of luteinizing hormone and follicle stimulating hormone.