Absent Periods

Definition

Menstruation, or a menstrual period, refers to the monthly process in which the uterus sheds blood and tissue because pregnancy did not occur.

Not having or missing a menstrual period is called amenorrhea. The types are:

• Primary—Menstruation has not begun in an adolescent around 16 years of age. Most females begin menstruating between 9-18 years of age, though the average is 12 years of age.
• Secondary—A woman who has previously menstruated misses 3 or more periods in a row.

Menstrual Flow

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Causes

The most common cause of secondary amenorrhea is pregnancy. In non-pregnant women, it may be due to a variety of factors.

Risk Factors

Factors that may increase the risk of amenorrhea include:

• Dramatic weight loss (which can occur from extreme diets, eating disorders, or excessive exercise) or dramatic weight gain
• Malnutrition
• Birth defects, including lack of female reproductive organs
• Chromosomal or hormonal abnormalities
• Certain conditions, such as a thyroid disorder or pituitary tumor
• Medications, such as 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 years or older. The main symptom for secondary amenorrhea is 3 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

You will be asked about your symptoms and medical history. A physical exam will be done.

Your bodily fluids may be tested. This can be done with:

• Blood tests
• Urine tests

Images may be taken of your bodily structures. This can be done with:

• MRI scan
• Ultrasound

Treatment

Treatment will depend on what is causing amennorrhea. 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—Hormonal therapy may be needed.
• Emotional distress—Relaxation techniques, therapy, and exercise may help to decrease stress.
• Pituitary tumor—Surgery, radiation therapy, or medication 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.