(Absent Menses; Amenorrhea)
DefinitionMenstruation, or a menstrual period, refers to the monthly process in which the uterus sheds blood and tissue to prepare for pregnancy.Not having or missing a menstrual period is called amenorrhea. This condition is divided into two types:
- Primary amenorrhea—when an adolescent female has not yet begun menstruation by around age 16 years
- Most females begin menstruating between the ages 9-18, but age 12 is the average.
- Secondary amenorrhea—when a woman who has previously menstruated misses three or more periods in a row
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CausesThe most common cause of secondary amenorrhea is pregnancy. In nonpregnant women, it may be due to a variety of factors.
Risk FactorsFactors that may increase the risk of amenorrhea include:
- Dramatic weight loss (such as from extreme diets, eating disorders, or excessive exercise) or dramatic weight gain
- Birth defects, including lack of female reproductive organs
- Chromosomal or hormonal abnormalities
- Certain conditions such as thryoid disorder and pituitary tumor
- Medications such as certain contraceptives
- Emotional distress
- Uterine scarring
SymptomsThe main symptom for primary amenorrhea is the absence of a menstrual period in a female by age 16 or older. The main symptom for secondary amenorrhea is three or more missed periods in a row in a woman who has previously had menstrual periods.
When Should I Call My Doctor?Call your doctor if you:
- Have not had your first period and are aged 16 years or older
- Miss having your period
DiagnosisYou will be asked about your symptoms and medical history. A physical exam will be done.Your bodily fluids may be tested. This can be done with:
- Blood tests
- Urine tests
TreatmentTreatment will depend on what is causing amennorhea. Examples include:
- Weight-related cause—A healthy caloric intake and exercise routine usually restores hormonal balance and menstruation.
- Birth defect—Surgery may be needed.
- Hormonal irregularity—Hormanal therapy may be needed.
- Emotional distress—Relaxation techniques, therapy, and exercise may help to decrease stress.
- Pituitary tumor—Surgery, radiation therapy , or medication may be needed.
PreventionAmenorrhea may or may not be preventable, depending on the cause. Follow these general guidelines to prevent amenorrhea:
- Maintain an appropriate level of body fat.
- Get help for an eating disorder.
- Treat conditions that can lead to amenorrhea, such as polycystic ovary syndrome, pituitary tumor, and hypothyroidism.
The American Congress of Obstetricians and Gynecologists
Women's Health—US Department of Health and Human Services
The Society of Obstetricians and Gynaecologists of Canada
Amenorrhea. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 7, 2014. Accessed August 8, 2014.
Amenorrhea. Family Doctor—American Academy of Family Physicians website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/amenorrhea.html. Updated February 2014. Accessed August 8, 2014.
Current evaluation of amenorrhea. American Society for Reproductive Medicine website. Available at: http://www.asrm.org/uploadedFiles/ASRM%5FContent/News%5Fand%5FPublications/Practice%5FGuidelines/Educational%5FBulletins/Current%5Fevaluation(1).pdf. Accessed August 8, 2014.
- Reviewer: Andrea Chisholm, MD
- Review Date: 08/2014
- Update Date: 08/08/2014
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