Amenorrhea is the absence of menstruation. Menstruation is a woman's monthly period.
Primary amenorrhea is when a girl has not yet started her monthly periods, and she:
See also:
Alternative NamesPrimary amenorrhea; No periods - primary; Absent periods - primary; Absent menses - primary; Absence of periods - primary
Causes, incidence, and risk factorsMost girls begin menstruating between ages 9 and 18, with an average around 12 years old. Primary amenorrhea typically occurs when a girl is older than 15, if she has undergone other normal changes that occur during puberty. Primary amenorrhea may occur with or without other signs of puberty.
Being born with poorly formed genital or pelvic organs (missing uterus or vagina, vaginal septum, cervical stenosis, or imperforate hymen) can lead to primary amenorrhea.
Hormones play a big role in a woman's menstrual cycle. Hormone problems can occur when:
These problems may be due to:
In many cases, the cause of primary amenorrhea is not known.
Conditions associated with primary amenorrhea include:
A female with amenorrhea will have no menstrual flow with or without other signs of puberty.
Signs and testsThe doctor will perform a physical exam and ask questions about your medical history. A pregnancy test will be done.
Blood tests may include:
Other tests that may be done include:
Treatment depends on the cause of the missing period. Primary amenorrhea caused by birth defects may require medications (hormones), surgery, or both.
If the amenorrhea is caused by a tumor in the brain (pituitary tumor):
If the condition is caused by a body-wide (systemic) disease, treatment of the disease may allow menstruation to begin.
If the amenorrhea is due to low weight because of anorexia or too much exercise, periods will often begin when the weight returns to normal or the exercise level is decreased.
Expectations (prognosis)Overall the outlook is good, depending on the cause of the amenorrhea. If the amenorrhea is caused by one of the following conditions, there is a good chance that it can be corrected with medication, lifestyle changes, or surgery:
Periods are unlikely to start on their own if the amenorrhea was caused by one of the following conditions:
If the amenorrhea cannot be corrected, it is sometimes possible to create a menstrual-like situation (pseudomenstruation) with medications. Medicines can help you feel more like your friends or family, and will also protect the bones from becoming too thin (osteoporosis).
ComplicationsCall your health provider if your daughter is older than age 16 and has not yet begun menstruating, or if she is 14 and shows no other signs of puberty.
ReferencesLobo RA. Primary and secondary amenorrhea and precocious puberty: Etiology, diagnostic evaluation, management. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 38.
Master-Hunter T, Heiman DL. Amenorrhea: evaluation and treatment. Am Fam Physician. 2006;73(8):1374-1382.
Amenorrhea is the absence of menstruation. Menstruation is a woman's monthly period.
Primary amenorrhea is when a girl has not yet started her monthly periods, and she:
See also:
Alternative NamesPrimary amenorrhea; No periods - primary; Absent periods - primary; Absent menses - primary; Absence of periods - primary
Causes, incidence, and risk factorsMost girls begin menstruating between ages 9 and 18, with an average around 12 years old. Primary amenorrhea typically occurs when a girl is older than 15, if she has undergone other normal changes that occur during puberty. Primary amenorrhea may occur with or without other signs of puberty.
Being born with poorly formed genital or pelvic organs (missing uterus or vagina, vaginal septum, cervical stenosis, or imperforate hymen) can lead to primary amenorrhea.
Hormones play a big role in a woman's menstrual cycle. Hormone problems can occur when:
These problems may be due to:
In many cases, the cause of primary amenorrhea is not known.
Conditions associated with primary amenorrhea include:
A female with amenorrhea will have no menstrual flow with or without other signs of puberty.
Signs and testsThe doctor will perform a physical exam and ask questions about your medical history. A pregnancy test will be done.
Blood tests may include:
Other tests that may be done include:
Treatment depends on the cause of the missing period. Primary amenorrhea caused by birth defects may require medications (hormones), surgery, or both.
If the amenorrhea is caused by a tumor in the brain (pituitary tumor):
If the condition is caused by a body-wide (systemic) disease, treatment of the disease may allow menstruation to begin.
If the amenorrhea is due to low weight because of anorexia or too much exercise, periods will often begin when the weight returns to normal or the exercise level is decreased.
Expectations (prognosis)Overall the outlook is good, depending on the cause of the amenorrhea. If the amenorrhea is caused by one of the following conditions, there is a good chance that it can be corrected with medication, lifestyle changes, or surgery:
Periods are unlikely to start on their own if the amenorrhea was caused by one of the following conditions:
If the amenorrhea cannot be corrected, it is sometimes possible to create a menstrual-like situation (pseudomenstruation) with medications. Medicines can help you feel more like your friends or family, and will also protect the bones from becoming too thin (osteoporosis).
ComplicationsCall your health provider if your daughter is older than age 16 and has not yet begun menstruating, or if she is 14 and shows no other signs of puberty.
ReferencesLobo RA. Primary and secondary amenorrhea and precocious puberty: Etiology, diagnostic evaluation, management. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 38.
Master-Hunter T, Heiman DL. Amenorrhea: evaluation and treatment. Am Fam Physician. 2006;73(8):1374-1382.
Reviewed ByReview Date: 06/16/2010
Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
Primary amenorrhea refers to not having a menstrual period at the age of puberty.
The only symptom of primary amenorrhea is delayed menstruation.
In secondary amenorrhea, the primary symptom is the ceasing of menstruation for at least three months.
Primary amenorrhea occurs when a girl at least 16 years old is not menstruating.
Pregnancy.
In 2003, a group of researchers reported on a new genetic mutation associated with primary amenorrhea.
Typical causes of primary amenorrhea include: excessive physical activity.drastic weight loss.extreme obesity.drugs.chronic illness.turner's syndrome.the absence of a vagina or a uterus.imperforate hymen
In addition to low body weight or excessive exercise, other causes of primary amenorrhea include Turner's syndrome, a birth defect related to the reproductive system, or ovarian problems.
Some of the causes of primary amenorrhea can also cause secondary amenorrhea.The most common cause of seconardy amenorrhea is pregnancy.The cessation of menstruation also occurs permanently after menopause or a hysterectomy.
Meduri, G., P. Touraine, I. Beau, et al. "Delayed Puberty and Primary Amenorrhea Associated with a Novel Mutation of the Human Follicle-Stimulating Hormone Receptor.
Primary amenorrhea caused by a congenital condition cannot be prevented.however, women should maintain a healthy diet, with plenty of exercise, rest, and not too much stress, avoiding smoking.However,many cases of amenorrhea cannot be prevented.
If women have genetic or hormonal abnormalities, amenorrhea is often treated with oral contraceptives that contain combinations of estrogen and progestin.