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Primary amenorrhea; No periods - primary; Absent periods - primary; Absent menses - primary; Absence of periods - primary
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:
Most 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.
The 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.
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).
Call 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.
Lobo 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.
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