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Alternative names Return to top
Missed periods; Lack of menses; Periods - missed; AmenorrheaDefinition Return to top
The absence of menstrual flow may be primary (menstruation fails to begin before age 16) or secondary (menstruation begins at the appropriate age, but later ceases for 6 or more months in the absence of normal causes such as pregnancy, lactation, or menopause).
Considerations Return to top
Many perfectly normal females begin to menstruate later than most (the median age is 12.8).
Pregnancy is often the first thought when a period is missed, but there are many reasons for having a late period.
The incidence of primary amenorrhea in the United States is less than 1%. The incidence of secondary amenorrhea (due to some cause other than pregnancy) is about 4% in the general population.
Increased risk is associated with extreme and prolonged exercise (particularly without adequate conditioning), body fat content less than 15% to 17%, extreme obesity, and taking hormonal supplements.
Symptoms associated with amenorrhea depend on the cause and may include the following:
Common Causes Return to top
Home Care Return to top
Treatment depends on the cause:
Call your health care provider if Return to top
What to expect at your health care provider's office Return to top
The medical history will be obtained and a physical examination performed.
A complete health history will be obtained, including a menstrual history. Questions may include the following:
A physical examination, including a pelvic examination, will be performed. In patients with secondary amenorrhea, physical and pelvic examinations must rule out pregnancy before diagnostic testing begins. The patient may be encouraged to discuss her fears and, if indicated, may be referred for psychological counseling.
Diagnostic tests that may be performed include:
Treatment depends on the cause of the amenorrhea. If it is caused by another systemic disorder, normal menstrual function usually returns after the primary disorder is treated. For example, if the primary disorder is hypothyroidism, then amenorrhea will be cured when the thyroid disorder is treated with thyroid supplements.
Pituitary tumors are usually treated with bromocriptine, a drug that inhibits prolactin secretion. Surgery removal may also be suggested. Radiation therapy is usually reserved for situations where other medical or surgical treatment regimens are not successful.
A progestin challenge may be used to determine a course of treatment. In this test, daily estrogen supplements are given in conjunction with intermittent progestin for 10 to 14 days per month every 1 to 3 months. Hormonal supplements are commonly utilized for those women who do not bleed in response to the progestin challenge test.
Women who bleed in response to the progestin challenge test are anovulatory -- they do not menstruate because they do not ovulate. This common cause of amenorrhea is treated by inducing ovulation with medication such as clomiphene citrate (Clomid) -- but only if the patient desires pregnancy. In patients who have no immediate plan for pregnancy, on the other hand, oral contraceptive pills may be prescribed to induce cyclic menstruation to prevent uncontrolled growth of the endometrial lining.
Young women with primary amenorrhea, found to be caused by developmental abnormalities, may require hormonal supplementation, surgery, or both. In any case, psychosocial support and counseling for the patient and family is necessary to address specific concerns and provide guidance regarding anticipated sexual development.
Update Date: 5/11/2004 Updated by: Sharon Roseanne Thompson, M.D., M.P.H., Clinical Fellow, Department of Obstetrics & Gynecology, Brigham and Women's Hospital, Boston, MA. Review provided by VeriMed Healthcare Network.
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Page last updated: 28 October 2004 |