General Information

Primary--Absence of menstruation in a young woman who is at least 16 years old or has reached age 14 with a lack of normal growth or absence of secondary sexual development. Secondary--Cessation of menstruation in a woman who has previously menstruated.

BODY PARTS INVOLVED--Endocrine system; reproductive system.

SEX OR AGE MOST AFFECTED--Females over age 16.

SIGNS & SYMPTOMS

• Lack of menstrual periods after puberty. Most girls begin menstruating by age 14.
• Absence of menstrual periods for 3 months in a female who has menstruated at least once.

CAUSES--

Usually unknown. Possible causes include:

• Congenital abnormalities, such as the absence or abnormal formation of female organs (vagina, uterus, ovaries).
• Intact hymen (membrane covering the vaginal opening) that has no opening to allow passage of menstrual flow.
• Disorders (tumors, infections or lack of maturation) of the endocrine system.
• Chromosome disorders.
• Emotional distress or eating disorders, including obesity, bulimia, anorexia nervosa, excessive dieting or starvation.
• Use of certain drugs, including mind-altering drugs, sedatives, hormones, oral contraceptives, anticancer drugs, barbiturates, narcotics, cortisone drugs, chlordiazepoxide and reserpine.
• Strenuous athletic activities. Other causes of secondary amenorrhea:
• Pregnancy or breast-feeding.
• Discontinuing use of birth-control pills.
• Menopause (if woman is over 35 and not pregnant).
• Surgical removal of ovaries or uterus.
• Diabetes mellitus, tuberculosis, obesity.

RISK INCREASES WITH--See Causes.

HOW TO PREVENT

• Use drugs only if prescribed by your doctor.
• Reduce strenuous athletic activities.
• Medical treatment for underlying disorders.
• Maintain proper nutrition and body weight.

What To Expect

DIAGNOSTIC MEASURES--

• Laboratory studies, such as a buccal smear (cells scraped from inside the cheek for chromosome studies), blood tests of hormone levels, thyroid and adrenal function tests.
• Pregnancy test and surgical diagnostic procedures, such as laparoscopy, hysteroscopy or dilatation and curettage.

APPROPRIATE HEALTH CARE

• Psychotherapy or counseling, if needed.
• Surgery (minor) to create an opening in the hymen, if necessary, or to correct abnormalities of the reproductive system (sometimes).

POSSIBLE COMPLICATIONS--Psychological distress about sexual development. May experience estrogen deficiency symptoms, such as hot flashes, vaginal dryness. May affect fertility.

PROBABLE OUTCOME--

• Primary--The absence of menstruation is not a health risk and is usually curable with hormone treatment or removal of the underlying cause. Treatment may be delayed to age 18 unless the cause can be identified and treated.
• Secondary--If from pregnancy or breast-feeding, menstruation will resume when these conditions cease. If from discontinuing use of oral contraceptives, periods should begin in 2 months to 2 years. If from menopause, periods will become less frequent or may never resume. If from endocrine disorders, hormone replacement usually causes periods to resume. If from eating disorders, successful treatment of the disorder is necessary. If from diabetes or tuberculosis, menstruation may never resume. If from strenuous exercise, periods usually resume when exercise decreases.

How To Treat

GENERAL MEASURES--

• Seek help in resolving emotional stress.
• Don't use mood-altering, mind-altering stimulants or sedative drugs.

MEDICATION--Your doctor may prescribe progesterone (hormone) treatment to induce bleeding. If bleeding begins when progesterone is withdrawn, the reproductive system is functioning. If progesterone withdrawal does not induce bleeding, gonad stimulants such as clomiphene or gonadotrophins may be used.

ACTIVITY--No restrictions.

DIET--If overweight or underweight, a change in diet to correct the problem is recommended.

Call Your Doctor If