Amenorrhea
Amenorrhea is when a girl or woman does not have her period. Primary amenorrhea is when periods have not started by age 16. Hormone levels and anatomical problems can cause amenorrhea.
What Is Amenorrhea?
Amenorrhea means a lack of menstrual periods. Primary amenorrhea means a patient has never had her first menstrual cycle. Secondary amenorrhea means the patient had menstrual cycles, but they are no longer happening at healthy intervals.
What Causes Amenorrhea?
There are many causes of amenorrhea in teens and young women. The more common causes include:
- Pregnancy
- Polycystic ovarian syndrome
- Early menopause
- Exposure to certain medications or radiation
- Eating disorders
- Other hormonal abnormalities
- Brain tumors
- Constitutional delay
- Stress
Anatomic causes such as a congenitally absent uterus can cause primary amenorrhea.
What Are the Signs and Symptoms of Amenorrhea?
Girls should start puberty by the time they are 13 years old and menstruation by the time they are 15 years old. Any girls who have not met these milestones require evaluation. Also if a patient has started her menstrual cycles and goes more than three months between cycles, she requires evaluation.
How Is Amenorrhea Diagnosed?
The evaluation of amenorrhea begins with a careful medical, growth, pubertal, dietary, social and family history. Physical examination is required for height and weight as well as assessing pubertal changes and other signs of hormonal imbalances. Blood tests looking at hormone levels and other chromosomal or genetic markers are frequently ordered. Radiologic tests may include pelvic imaging with ultrasound or MRI, brain imaging with MRI, or a DXA (bone density) scan.
How Is Amenorrhea Treated?
Treatment of amenorrhea depends on the underlying cause. Treatment often focuses on correcting underlying abnormalities leading to the amenorrhea, protecting the uterine lining in the absence of regular menstrual cycles, and making sure the bones stay healthy as estrogen levels required to maintain bone health may be low in patients who are not having regular menstrual cycles. Amenorrhea treatment is tailored to keep patients healthy, maximizing both their general and reproductive health.
