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.
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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
- 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
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
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.
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.
This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.
Edits to original content made by Denver Health.
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a (Absent Menses; Amenorrhea)
The American Congress of Obstetricians and Gynecologists http://www.acog.org
Women's Health—Department of Health and Human Services http://www.womenshealth.gov
Health Canada https://www.canada.ca/en/health-canada.html
The Society of Obstetricians and Gynaecologists of Canada https://sogc.org
Amenorrhea. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T116009/Amenorrhea . Updated March 14, 2016. Accessed September 12, 2017.
Amenorrhea. Family Doctor—American Academy of Family Physicians website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/amenorrhea.html. Updated May 2017. Accessed September 12, 2017.
Current evaluation of amenorrhea. American Society for Reproductive Medicine website. Available at: http://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/practice-guidelines/for-non-members/current%5Fevaluation%5Fof%5Famenorrhea-pdfnoprint.pdf. Published 2008. Accessed September 12, 2017.