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

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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.

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:

• MRI scan of the pituitary gland
• Ultrasound

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.