Absent menstruation, or amenorrhea, is the absence of menstrual bleeding. It happens when a girl hasn’t had her first menstrual period by age 16. It also occurs then a woman fails to menstruate for 3 to 6 months.
Amenorrhea can happen for many reasons. The most common cause is pregnancy. However, amenorrhea may also be caused by various lifestyle factors, including body weight and exercise levels. In some cases, hormonal imbalances or problems with the reproductive organs might be the cause.
You should see your doctor if you’re experiencing amenorrhea. The underlying cause of your missed periods may require treatment.
The two types of amenorrhea are referred to as primary and secondary.
Primary amenorrhea is when a teenage girl has reached or passed the age of 16 and still hasn’t had her first period. Most girls begin menstruating between ages 9 and 18, but 12 is the average age.
Secondary amenorrhea is when a woman has stopped menstruating for at least three months. This is the more common form of amenorrhea.
In most cases, both types can be treated effectively.
Primary and secondary amenorrhea can occur for numerous reasons. Some causes are natural, while others are medical conditions that need to be treated.
- Natural causes most likely to cause amenorrhea include pregnancy, breast-feeding, and menopause.
- Lifestyle factors may include excessive exercise and stress. Also, having too little body fat or too much body fat may also delay or stop menstruation.
- Hormonal imbalances may cause amenorrhea. They are usually triggered by tumors on the pituitary gland or the thyroid gland. Low estrogen levels or high testosterone levels can also cause them.
- Medications can cause amenorrhea in some women. Antipsychotics and antidepressants are often involved. Chemotherapy drugs and medications that treat high blood pressure can cause problems with menstruation as well. Suddenly stopping birth control pills may also lead to several months of absent periods before the cycle returns to normal.
- Physical defects such as structural problems in the female reproductive organs might be responsible for absent or delayed menstruation. These issues can result from birth defects, tumors, or infections that occurred in the womb or shortly after birth. In rare cases, missed periods could be a symptom of Asherman’s syndrome. This occurs due to scarring in the uterus after surgery, which can prevent mestruation.
- Genetic disorders or chromosomal disorders, such as Turner syndrome and Sawyer syndrome, can sometimes cause late menstruation.
A teenage girl who hasn’t started her periods by at least age 16 should see a doctor. A trip to the doctor’s office is also necessary if she is age 14 or older and hasn’t experienced any signs of puberty yet. These changes would include the following in numbered order of appearance:
- thelarche (breast bud development)
- pubarche (pubic hair development)
- menarche (onset of menstrual periods)
Menstruating women and teens should see their doctor if they have missed three or more periods in a row.
When you see your doctor about amenorrhea, your doctor will perform a physical exam and ask you a series of questions. Be prepared to talk about your normal menstrual cycle, your lifestyle, and any other symptoms you’re experiencing. Your doctor will also order a pregnancy test if you haven’t had a period in three months. If that condition is ruled out, you may need more tests to determine the underlying cause of your missed periods. These diagnostic tests may include:
- Blood tests, which will allow your doctor to check hormone levels in your body. Prolactin, luteinizing hormone, and follicle stimulating hormone are all related to menstruation. Determining these levels can help your doctor determine or rule out the cause of your absent periods.
- Ultrasound is an imaging test that uses high frequency sound waves to create detailed pictures of the inside of your body. It enables your doctor to view various organs, such as the ovaries and uterus, and check for abnormal growths.
- CT scan is another type of imaging test that uses computers and rotating X-ray machines to create cross-sectional images of the body. These images allow your doctor to look for masses and tumors in your glands and organs.
Treatment for amenorrhea varies depending on the underlying cause. Hormonal imbalances can be treated with supplemental or synthetic hormones, which can help normalize hormone levels. Your doctor may also want to remove ovarian cysts, scar tissue, or uterine lesions that are causing you to miss your menstrual periods.
Your doctor may also recommend making simple lifestyle changes if your weight or exercise routine is contributing to your condition. Ask your doctor to refer you to a nutritionist or dietician, if necessary. These specialists can teach you how to manage your weight and physical activity in a healthy way.
Schedule an appointment with your doctor so they can determine the cause of your amenorrhea. Make sure you stick with your treatment plan and attend all follow-up appointments. Always contact your doctor if your condition doesn’t improve with medical treatments or lifestyle modifications.