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 of around 12 years old. Primary amenorrhea typically occurs when a girl is older than 15, if she has gone through 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 can lead to primary amenorrhea. Some of these defects include:
Hormones play a big role in a woman's menstrual cycle. Hormone problems can occur when:
Either of these problems may be due to:
In many cases, the cause of primary amenorrhea is not known.
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 anorexia or too much exercise, periods will often begin when the weight returns to normal or the exercise level is decreased.
If the amenorrhea cannot be corrected, medicines can sometimes create a menstrual-like situation (pseudomenstruation). Medicines can help the woman feel more like her friends and family, and protect the bones from becoming too thin (osteoporosis).
The outlook depends on the cause of the amenorrhea and whether it can be corrected with treatment or lifestyle changes.
Periods are unlikely to start on their own if the amenorrhea was caused by one of the following conditions:
You may have emotional distress because you feel different from friends or family, or worry that you might not be able to have children.
Call your health care provider if your daughter is older than 15 and has not yet begun menstruating, or if she is 14 and shows no other signs of puberty.
Primary amenorrhea; No periods - primary; Absent periods - primary; Absent menses - primary; Absence of periods - primary
Lobo RA. Primary and secondary amenorrhea and precocious puberty: etiology, diagnostic evaluation, management. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, , eds. Comprehensive Gynecology. 6th ed. Philadelphia, Pa: Mosby Elsevier; 2012:chap 38.
Styne DM, Grumbach MM. Puberty, ontogeny, neuroendocrinology, physiology, and disorders. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology, 12th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 25.
Bulun SE. The physiology and pathology of the female reproductive axis. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology, 12th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 17.
Updated by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington; and Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.
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