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
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:
- MRI scan of the pituitary gland
- Ultrasound
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
There are no clear guidelines for preventing amenorrhea.
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