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Menstruation - absent
Alternative namesMissed periods; Lack of menses; Periods - missed; Amenorrhea
The absence of menstrual flow, either primary (menstruation fails to begin before age 16) or secondary (menstruation begins at the appropriate age, but later ceases for 6 or more months in the absence of normal causes such as pregnancy, lactation, or menopause ).
Many perfectly normal females begin to menstruate later than most (the median age is 12.8).
Pregnancy is often the first thought when a period is missed, but there are many reasons for having a late period.
The incidence of primary amenorrhea in the United States is less than 1%. The incidence of secondary amenorrhea (due to some cause other than pregnancy) is about 4% in the general population.
Increased risk is associated with extreme and prolonged exercise (particularly without adequate conditioning), body fat content less than 15% to 17%, extreme obesity, and taking hormonal supplements.
Symptoms associated with amenorrhea may include headache , galactorrhea (breasts produce milk in a woman who is not pregnant or breast feeding an infant), visual loss (in rare cases of pituitary tumor), marked weight gain or weight loss , dry vagina , increased hair growth in a "male" pattern ( hirsutism ), voice changes, and breast size changes.
Treatment depends on the cause. For amenorrhea caused by normal delay of menstruation onset, have patience until age 16. For a missed period that may be caused by pregnancy, consult your obstetrician to confirm pregnancy. For a missed period caused by drastic weight loss or obesity , proper diet is recommended. For a missed period resulting from excessive exercise, use moderation and cut back to a more conservative program.
Call your health care provider if
The medical history will be obtained and a physical examination performed.
A complete health history will be obtained including a menstrual history. Questions may include:
A physical examination, including a pelvic examination, will be performed. In patients with secondary amenorrhea , physical and pelvic examinations must rule out pregnancy before diagnostic testing begins. The patient may be encouraged to discuss her fears and, if indicated, may be referred for psychological counseling.
Diagnostic tests that may be performed include:
Pituitary tumors are usually treated with bromocriptine, a drug that inhibits prolactin secretion. Surgery removal may also be suggested. Radiation therapy is usually reserved for situations where other medical or surgical treatment regimens are not successful.
Hormonal supplements are commonly utilized for those women who do not bleed in response to the progestin challenge test. Daily estrogen supplements are given in conjunction with intermittent progestin for 10 to 14 days per month every 1 to 3 months.
Women who bleed in response to the progestin challenge test are anovulatory --they do not menstruate because they do not ovulate. This common cause of amenorrhea is treated by inducing ovulation with medication such as clomiphene citrate (Clomid) -- but only if the patient desires pregnancy. In patients who have no immediate plan for pregnancy, on the other hand, oral contraceptive pills may be prescribed to induce cyclic menstruation to prevent uncontrolled growth of the endometrial lining.
Young women with primary amenorrhea , found to be caused by developmental abnormalities, may require hormonal supplementation, surgery, or both. In any case, psychosocial support and counseling for the patient and family is necessary to address specific concerns and provide guidance regarding anticipated sexual development.
After seeing your health care provider:
Update Date: 1/20/2002Peter Chen, M.D., Department of Obstetrics & Gynecology, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network.
Last updated: Tue, 06 Jan 2009 00:20:03 GMT