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Absent menstrual periods - primary

Primary amenorrhea; No periods - primary; Absent periods - primary; Absent menses - primary; Absence of periods - primary

 

Absence of a woman's monthly menstrual period is called amenorrhea.

Primary amenorrhea is when a girl has not yet started her monthly periods, and she:

  • Has gone through other normal changes that occur during puberty
  • Is older than 15

Causes

 

Most girls begin their periods between ages 9 and 18. The average is around 12 years old. If no periods have occurred when a girl is older than 15, further testing may be needed. The need is more urgent if she has gone through other normal changes that occur during puberty.

Being born with incompletely formed genital or pelvic organs can lead to a lack of menstrual periods. Some of these defects include:

  • Blockages or narrowing of the cervix
  • Hymen that has no opening
  • Missing uterus or vagina
  • Vaginal septum (a wall that divides the vagina into 2 sections)

Hormones play a big role in a woman's menstrual cycle. Hormone problems can occur when:

  • Changes occur to the parts of the brain where hormones that help manage the menstrual cycle are produced.
  • The ovaries are not working correctly.

Either of these problems may be due to:

  • Anorexia (loss of appetite)
  • Chronic or long-term illnesses, such as cystic fibrosis or heart disease
  • Genetic defects or disorders
  • Infections that occur in the womb or after birth
  • Other birth defects
  • Poor nutrition
  • Tumors

In many cases, the cause of primary amenorrhea is not known.

 

Symptoms

 

A female with amenorrhea will have no menstrual flow. She may have other signs of puberty.

 

Exams and Tests

 

The health care provider will perform a physical exam to check for birth defects of the vagina or uterus.

The provider will ask questions about:

  • Your medical history
  • Medicines and supplements you may be taking
  • How much exercise you do
  • Your eating habits

A pregnancy test will be done.

Blood tests to measure different hormone levels may include:

  • Estradiol
  • FSH
  • LH
  • Prolactin
  • 17 hydroxyprogesterone
  • Serum progresterone
  • Serum testosterone level
  • TSH
  • T3 and T4

Other tests that may be done include:

  • Chromosome or genetic testing
  • Head CT scan or head MRI scan to look for brain tumors
  • Pelvic ultrasound to look for birth defects

 

Treatment

 

Treatment depends on the cause of the missing period. Lack of periods that is caused by birth defects may require hormone medicines, surgery, or both.

If the amenorrhea is caused by a tumor in the brain:

  • Medicines may shrink certain types of tumors.
  • Surgery to remove the tumor may also be needed.
  • Radiation therapy is usually only done when other treatments have not worked.

If the problem is caused by a bodywide disease, treatment of the disease may allow menstruation to begin.

If the cause is the bulimia , anorexia or too much exercise, periods will often begin when the weight returns to normal or the exercise level is decreased.

If the amenorrhea cannot be corrected, hormone medicines can sometimes be used. Medicines can help the woman feel more like her friends and female family members. They can also protect the bones from becoming too thin ( osteoporosis ).

 

Outlook (Prognosis)

 

The outlook depends on the cause of the amenorrhea and whether it can be corrected with treatment or lifestyle changes.

Periods are not likely to start on their own if the amenorrhea was caused by one of the following conditions:

  • Birth defects of the female organs
  • Craniopharyngioma (a tumor near the pituitary gland at the base of the brain)
  • Cystic fibrosis
  • Genetic disorders

You may have emotional distress because you feel different from friends or family. Or you may worry that you might not be able to have children.

 

When to Contact a Medical Professional

 

Call your provider if your daughter is older than 15 and has not yet begun menstruating, or if she is 14 and shows no other signs of puberty.

 

 

Open References

References

Bulun SE. The physiology and pathology of the female reproductive axis. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology . 13th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 17.

Lobo RA. Primary and secondary amenorrhea and precocious puberty: etiology, diagnostic evaluation, management. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology . 6th ed. Philadelphia, PA: Elsevier; 2012:chap 38.

Styne DM, Grumbach MM. Physiology and disorders of puberty. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology . 13th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 25.

 
  • Primary amenorrhea

    Primary amenorrhea - illustration

    Primary amenorrhea is the absence of the menstrual period by the age of 16. Treatment of amenorrhea may range from hormonal supplementation for developmental abnormalities of the reproductive system to surgery for tumors of the pituitary.

    Primary amenorrhea

    illustration

  • Normal uterine anatomy (cut section)

    Normal uterine anatomy (cut section) - illustration

    The uterus is a muscular organ with thick walls, two upper openings to the fallopian tubes and an inferior opening to the vagina.

    Normal uterine anatomy (cut section)

    illustration

  • Absence of menstruation (amenorrhea)

    Absence of menstruation (amenorrhea) - illustration

    Amenorrhea is the lack of menstrual flow and can be a normal occurrence or a sign of malfunction or disease. In primary amenorrhea, menstruation does not begin when expected (by the age of 16). Secondary amenorrhea occurs when the normal established menstrual cycle is shut down for 6 or more months due to a condition other than pregnancy, breastfeeding or menopause.

    Absence of menstruation (amenorrhea)

    illustration

    • Primary amenorrhea

      Primary amenorrhea - illustration

      Primary amenorrhea is the absence of the menstrual period by the age of 16. Treatment of amenorrhea may range from hormonal supplementation for developmental abnormalities of the reproductive system to surgery for tumors of the pituitary.

      Primary amenorrhea

      illustration

    • Normal uterine anatomy (cut section)

      Normal uterine anatomy (cut section) - illustration

      The uterus is a muscular organ with thick walls, two upper openings to the fallopian tubes and an inferior opening to the vagina.

      Normal uterine anatomy (cut section)

      illustration

    • Absence of menstruation (amenorrhea)

      Absence of menstruation (amenorrhea) - illustration

      Amenorrhea is the lack of menstrual flow and can be a normal occurrence or a sign of malfunction or disease. In primary amenorrhea, menstruation does not begin when expected (by the age of 16). Secondary amenorrhea occurs when the normal established menstrual cycle is shut down for 6 or more months due to a condition other than pregnancy, breastfeeding or menopause.

      Absence of menstruation (amenorrhea)

      illustration

    A Closer Look

     

    Self Care

     

      Tests for Absent menstrual periods - primary

       
         

        Review Date: 5/16/2016

        Reviewed By: Irina Burd, MD, PhD, Associate Professor of Gynecology and Obstetrics at Johns Hopkins University School of Medicine, Baltimore, MD. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

        The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

         
         
         

         

         

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