Absent Periods

(Absent Menses; Amenorrhea)
  • Definition

    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
    Menstrual Flow
    Menstrual Flow
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  • Causes

    The most common cause of secondary amenorrhea is pregnancy. If nonpregnant women, may be due to a variety of factors.
  • Risk 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 gain
    • Malnourishment
    • Birth defects (eg, lack of female reproductive organs)
    • Chromosomal or hormonal abnormalities
    • Certain conditions (eg, thryoid disorder, pituitary tumor )
    • Medicines (eg, 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 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
  • Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will also be done.
    Tests may include:
    • Pregnancy test
    • Progestin challenge test to determine if a lack of estrogen is causing amenorrhea
    • Blood work to check hormone levels
    • Chromosome test to determine if there are any abnormalities
    Other tests that may be ordered include:
  • Treatment

    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.
    • Pituitary tumor—Surgery, radiation therapy , or medicine 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/

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

    CANADIAN RESOURCES

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

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

    References

    Amenorrhea. Family Doctor.org website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/amenorrhea.html . Updated August 2010. Accessed August 13, 2012.

    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 13, 2012.

    Secondary amenorrhea. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/ . Updated February 3, 2012. Accessed August 13, 2012.

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