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Menstruation - absent

• Overview
• Treatment

Alternative Names:

Missed periods; Lack of menses; Periods - missed; Amenorrhea

Home Care:

Treatment depends on the cause.

• For amenorrhea caused by normal delay of menstruation onset, have patience until age 16. However, keep in mind that the delay is only normal if the girl displays some signs of puberty, such as breast development
• Consult your obstetrician to determine if you may be pregnant.
• For a missed period caused by drastic weight loss or obesity , proper diet is recommended.
• For a missed period resulting from excessive exercise, cut back to a more conservative workout program.

Call your health care provider if:

• You have never had a menstrual period and you are age 16 or older
• You have previously menstruated but have missed 3 or more periods in a row

What to expect at your health care provider's office:

The first step is to rule out pregnancy. This is done with a urine or blood test.

Next, the doctor will perform a physical exam and ask questions about your medical history, which may include the following:

• Menstrual history
  • Are you a woman presently in a menstruating age range (over 12 and under 55)?
  • Are you sexually active?
  • Do you use birth control ? What type?
• Quality
  • Was the previous menstrual period a normal amount?
  • Are the menses absent or decreased?
  • Do you usually have regular periods?
• Time pattern
  • When was your last menstrual period?
  • At what age did you have your first menstrual period?
  • Have you ever had normal periods?
• Aggravating factors
  • What medications do you take?
  • How much do you exercise?
• Other symptoms
  • What other symptoms are also present?
  • Is there breast tenderness ?
  • Is there morning nausea and vomiting ?
  • Is there a headache ?
  • Is there a nipple discharge (and not breast feeding)?
  • Is there vision loss or change in vision?
  • Is there an unintentional weight gain ?
  • Is there an unintentional weight loss ?
  • Is there hair growth in a male pattern?
  • Is there excessive anxiety ?

Tests that may be performed include:

• Progestin withdrawal (take a hormonal medicine for 7 to 10 days to trigger bleeding)
• Prolactin level
• Serum hormone levels such as testosterone levels
• Thyroid function studies , including TSH ( thyroid stimulating hormone
• Pregnancy test ( serum HCG )
• FSH ( follicle stimulating hormone level)
• LH ( luteinizing hormone level)
• Pelvic ultrasound
• CT scan of the head may be done if a pituitary tumor is suspected

Treatment depends on the cause of the amenorrhea. Your doctor may tell you to make lifestyle changes if the absent menstruation is due to weight changes, physical activity, or stress level. If you have polycystic ovarian syndrome or athletic amenorrhea, you may be given hormonal contraceptives to treat the problem.

If the absent menstruation is caused by another systemic disorder, normal menstrual function usually returns after the primary disorder is treated. For example, if the primary disorder is thyroid or pituitary disease, medicines will be prescribed.

Young women with primary amenorrhea that is caused by birth defects may require medicine, 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.

• Review Date: 6/6/2006
• Reviewed By: Audra Robertson, MD, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA. Review provided by VeriMed Healthcare Network.

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