Amenorrhea refers to the absence of a menstrual cycle.
occurs if an adolescent female has not yet begun menstruation by around age 16 or so.
describes a condition in which a woman who has previously menstruated on a regular basis misses three or more periods in a row. In the United States, amenorrhea affects between 2-5% of women.
Most females begin menstruating between the ages of 9-18, but age 12 is the average. Menstruation, or a menstrual period, refers to the monthly process in which the uterus sheds blood and tissue in preparation for pregnancy.
If a female has not started her menstrual period by age 16, a doctor should be contacted to determine the cause and prescribe any treatment that may be necessary.
Secondary amenorrhea is most commonly caused by pregnancy. But in nonpregnant women, amenorrhea may result from a variety of factors, including an existing medical condition, lifestyle, emotional distress, hormonal irregularity, or medication. Every effort should be made to determine the exact cause. Specific causes of amenorrhea include:
Dramatic weight loss, particularly from drastic diets, eating disorders including
, or excessive exercise
Dramatic weight gain or morbid obesity
Birth defects including lack of a uterus, vagina, or other reproductive organs
Psychological stress—can lead to a hormonal imbalance sufficient to cause amenorrhea.
Medications—some antidepressants, chemotherapeutics, corticosteroids, certain contraceptives.
Hermaphroditism (having both male and female reproductive organs)
Women who eat a diet that doesn’t provide sufficient caloric intake, exercise excessively, or suffer under considerable psychological distress are more likely to experience amenorrhea.
Women born with chromosomal or hormonal abnormalities, as well as those who suffer from certain chronic diseases, are also more likely to experience amenorrhea.
The main symptom of primary amenorrhea is the absence of a menstrual period in girls age 16 or older. The main symptom of secondary amenorrhea is three or more missed periods in a row in a woman who has previously had a regular period.
If you experience any of these symptoms, don’t assume that the cause of your amenorrhea is something serious. If you’re sexually active, the first thing to do is to determine if you’re pregnant. Then see your physician to get a proper diagnosis.
Your doctor will ask about your symptoms and medical history, and perform a physical exam.
Tests may include the following:
Blood work to determine hormone levels
Chromosome test to determine if any abnormalities exist
Progestin challenge test (taking progestogen for 7-10 days to trigger bleeding in order to determine if lack of estrogens is responsible for amenorrhea)
CT scan of the head
—a type of x-ray that uses a computer to make pictures of structures of the head, brain, and skull
Hormonal irregularity—hormone therapy, including oral contraceptives, may cause menstruation to begin
Weight related—improved diet, including healthy caloric intake and a reasonable exercise routine usually restores hormonal balance and menstruation
Medical condition—if effective treatment is available, it may restore menstruation
Many cases of amenorrhea are unavoidable with the notable exceptions of pregnancy, eating disorders, and cases related to medications. Use effective contraception if you are sexually active and maintain a healthy body weight through a reasonable diet and exercise regimen. Seeking help during time of stress may also help prevent a bout of amenorrhea.
Please be aware that this information is provided to supplement the care
provided by your physician. It is neither intended nor implied to be a
substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER
IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the
advice of your physician or other qualified health provider prior to
starting any new treatment or with any questions you may have regarding a