| Risk Factors
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
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The most common cause of secondary amenorrhea is pregnancy. If nonpregnant women, may be due to a variety of 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
- Birth defects (eg, lack of female reproductive organs)
- Chromosomal or hormonal abnormalities
Certain conditions (eg, thryoid disorder,
- Medicines (eg, certain
- Emotional distress
- Uterine scarring
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.
Call your doctor if you:
- Have not had your first period and are aged 16 years or older
- Miss having your period
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:
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.
radiation therapy, or medicine may be needed.
Amenorrhea may or may not be preventable, depending on the cause. Follow these general guidelines to prevent amenorrhea:
- Maintain an appropriate level of body fat.
- Get help for an eating disorder.
- Treat conditions that can lead to amenorrhea, such as polycystic ovary syndrome, pituitary tumor, and hypothyroidism.
Amenorrhea. Family Doctor.org website. Available at:
http://familydoctor.org/familydoctor/en/diseases-conditions/amenorrhea.html. Updated August 2010. Accessed August 13, 2012.
Current evaluation of amenorrhea. American Society for Reproductive Medicine website. Available at:
http://www.asrm.org/uploadedFiles/ASRM_Content/News_and_Publications/Practice_Guidelines/Educational_Bulletins/Current_evaluation(1).pdf. Accessed August 13, 2012.
Secondary amenorrhea. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed/. Updated February 3, 2012. Accessed August 13, 2012.
Last reviewed September 2013 by Andrea Chisholm, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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