Menstruation, or a menstrual period, refers to the monthly process in which the uterus sheds blood and tissue in preparation 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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The most common cause of secondary amenorrhea is pregnancy. If nonpregnant women, may be due to a variety of factors.
Factors that may increase the risk of amenorrhea include: Dramatic weight loss (eg, from extreme diets, eating disorders, or excessive exercise) or dramatic weight gainMalnourishmentBirth defects (eg, lack of female reproductive organs)Chromosomal or hormonal abnormalities
Certain conditions (eg, thryoid disorder,
Medicines (eg, certain
contraceptives)Emotional distressUterine scarring
The 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.
Call your doctor if you: Have not had your first period and are aged 16 years or olderMiss having your period
Your doctor will ask about your symptoms and medical history. A physical exam will also be done.
Tests may include: Pregnancy testProgestin challenge test to determine if a lack of estrogen is causing amenorrheaBlood work to check hormone levelsChromosome test to determine if there are any abnormalities
Other tests that may be ordered include: MRI scan
of the pituitary gland
Treatment 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—Your doctor may prescribe hormonal therapy.Emotional distress—Relaxation techniques (eg, deep breathing), therapy, and exercise may help to decrease stress.
may be needed.
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.
Last reviewed September 2013 by Andrea Chisholm, MD
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 medical condition.
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