by Kohnle D
(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
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
There are no clear guidelines for preventing amenorrhea.
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.