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Absent Periods

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(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
Menstrual Flow
Menstrual Flow
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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.

Revision Information

  • Reviewer: Andrea Chisholm
  • Review Date: 09/2012 -
  • Update Date: 00/92/2012 -

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.

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