• Absent Periods

    (Absent Menses; Amenorrhea)

    Definition

    Menstruation, or a menstrual period, refers to the monthly process in which the uterus sheds blood and tissue because pregnancy did not occur.
    Not having or missing a menstrual period is called amenorrhea. The types are:
    • Primary—Menstruation has not begun in an adolescent around 16 years of age. Most females begin menstruating between 9-18 years of age, though the average is 12 years of age.
    • Secondary—A woman who has previously menstruated misses 3 or more periods in a row.
    Menstrual Flow
    Menstrual Flow
    Copyright © Nucleus Medical Media, Inc.

    Causes

    The most common cause of secondary amenorrhea is pregnancy. In non-pregnant women, it may be due to a variety of factors.

    Risk Factors

    Factors that may increase the risk of amenorrhea include:
    • Dramatic weight loss (which can occur from extreme diets, eating disorders, or excessive exercise) or dramatic weight gain
    • Malnutrition
    • Birth defects, including lack of female reproductive organs
    • Chromosomal or hormonal abnormalities
    • Certain conditions, such as a thyroid disorder or pituitary tumor
    • Medications, such as certain contraceptives
    • Emotional distress
    • Uterine scarring

    Symptoms

    The main symptom for primary amenorrhea is the absence of a menstrual period in a female by age 16 years or older. The main symptom for secondary amenorrhea is 3 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

    Diagnosis

    You 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
    Images may be taken of your bodily structures. This can be done with:

    Treatment

    Treatment will depend on what is causing amennorrhea. 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—Hormonal 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.

    Prevention

    Amenorrhea 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.

    RESOURCES

    The American Congress of Obstetricians and Gynecologists http://www.acog.org

    Office on Women's Health http://www.womenshealth.gov

    CANADIAN RESOURCES

    Health Canada http://www.hc-sc.gc.ca

    The Society of Obstetricians and Gynaecologists of Canada https://sogc.org

    References

    Amenorrhea. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116009/Amenorrhea. Updated March 14, 2016. Accessed September 27, 2016.

    Amenorrhea. Family Doctor—American Academy of Family Physicians website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/amenorrhea.html. Updated February 2014. Accessed October 7, 2015.

    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. Published 2008. Accessed October 7, 2015.

    Revision Information

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