AMENORRHEA, PRIMARY

 Basic information

description

Primary amenorrhea is complete absence of menstruation in a young woman who is at least 16 years old, or at age 14 with a lack of normal growth or absence of secondary sexual development. It is a rare disorder, as over 95% of girls have their first menstrual period by age 15. Most girls begin menstruating by age 14; average age is 12 years, 8 months.

FREQUENT SIGNS & SYMPTOMS

Lack of menstrual periods after puberty.

causes

A failure of certain complex body functions that normally result in menstruation. There are a number of disorders or health problems that can lead to the failure.

risk increases with

• Delayed puberty.
• Congenital problems, such as the absence or abnormal formation of female organs (vagina, uterus, and ovaries).
• Intact hymen (membrane covering the vaginal opening) has no opening to allow passage of menstrual flow.
• Disorders (tumors, infections, or other problems) of the endocrine system, including the pituitary, hypothalamus, thyroid, parathyroid, adrenal, and ovarian glands.
• Chromosome disorders or chronic illness.
• Polycystic ovaries (Stein-Leventhal syndrome).
• Pregnancy.
• Severe nutritional or physical stressors such as anorexia, competitive sports, or intense training (e.g., in gymnasts, ballet dancers, or long distance runners).
• Use of drugs, including oral contraceptives, anticancer drugs, barbiturates, narcotics, cortisone drugs, chlordiazepoxide, and reserpine.
• Family tendency to start menstruation late.
• Excessive dieting or weight loss.
• Extreme obesity.
• Rarely, prior gynecological surgery.

PREVENTIVE MEASURES

No specific preventive measures. Avoid risk factors where possible.

expected outcomes

• The absence of menstruation is not a health risk in itself, but the cause should be found.
• Amenorrhea is often curable with hormone treatment or treatment of the underlying cause. Treatment may be delayed to age 18, unless the cause can be identified and treated safely.
• Causes that sometimes cannot be corrected include chromosome disorders and abnormalities of the reproductive system.

possible complications

• Emotional stress about sexual development.
• May lead to infertility.
• Other complications may occur, depending on the underlying cause.

 diagnosis & treatment

general measures

• Your health care provider will do a physical exam and a pelvic exam. Questions will be asked about your medical history and your family's medical history, and about your lifestyle (e.g., diet, exercise, etc.). Medical testing may include urine and blood studies; hormone levels; and liver, thyroid, and adrenal function. Other tests may be done to diagnose an underlying disorder.
• Treatment may involve hormone replacement therapy. Treatment for amenorrhea not related to hormone deficiency depends on the cause.
• Counseling may help if amenorrhea is related to stress, results from an eating disorder, or for emotional concerns about sexual development.
• Surgery to correct abnormalities of the reproductive system or for cysts may rarely be needed.

medications

• Hormones may be prescribed if there is a hormone imbalance. They may correct the problem.
• Birth control pills may be prescribed for polycystic ovary syndrome.
• Bromocriptine may be prescribed for pituitary tumor.

activity

Exercise regularly, but not to excess. Reduce exercise or athletic activities if they are too strenuous.

diet

If overweight or underweight, a change in diet to correct the problem may bring on a period.

 notify our office if

• You are 16 years old and have never had a period.
• Periods don't begin within 6 months, despite treatment.

Special Notes: