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Amenorrhea - primary
Alternative namesPrimary amenorrhea; No periods; Absent periods; Absent menses
DefinitionThis condition is the absence of any menstrual flow in a woman who has never menstruated by the age of 16.
Causes, incidence, and risk factors
Most girls begin menstruating between ages 9 and 18, with an average around 12 years old. Primary amenorrhea is not considered to have occurred until a girl is beyond age 16, if she has undergone other normal changes that occur during puberty. Primary amenorrhea may occur with or without other signs of puberty.
There are many possible causes of primary amenorrhea:
Signs and tests
Treatment depends on the cause of the amenorrhea. Primary amenorrhea caused by developmental abnormalities (which may result when the parts of the female reproductive system did not form properly before birth) may require hormonal supplementation, surgery, or both.
Pituitary tumors , located in the brain, are usually treated with bromocriptine, a drug that inhibits the abnormally high prolactin secretion caused by these tumors. Surgical removal may also be necessary. Radiation therapy is usually reserved for situations in which other medical or surgical treatment regimens are not successful.
In any case, support and counseling for the patient and family is necessary. This will address specific concerns and provide guidance regarding anticipated sexual development.
If the problem causing the amenorrhea is not correctable, then the patient and health care provider should consider the possibility of creating pseudomenstruation. This is a menstrual period that is caused by hormonal treatment rather than natural causes.
For women who do not have other reproductive abnormalities, work up for amenorrhea is delayed until after age 16.
If the condition is caused by systemic disease, treatment of the disease should allow menstruation to begin.
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 possibility of correcting the amenorrhea through medication, lifestyle change, or surgery:
If the amenorrhea is caused by one of the following conditions, it is unlikely that the amenorrhea can be corrected by any intervention:
If the amenorrhea cannot be corrected, as long as there is a uterus, it may be possible to create a pseudomenstruation with medications to help the young woman feel more like her friends or family.
Emotional distress or crisis about being different from friends or family can occur.
Calling your health care provider
Call your health provider if your daughter is older than age 16 and has not yet begun menstruating.
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