Thursday, May 23, 2013

Menstruation - absent

Table of Contents

Definition

Absent menstruation means no menstrual flow, or period. Absent menstruation may be:

  • Primary -- no menstruation by age 16
  • Secondary -- menstruation begins at the appropriate age, but later stops for more than 3 cycles or 6 months

Absent menstruation is called amenorrhea.


Alternative Names

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


Considerations

Many perfectly healthy females begin to menstruate later than most (the average age is about 13).

Pregnancy is often the first thought when a period is missed, but there are many reasons for having a late period. The rate of primary amenorrhea in the United States is less than 1%. The rate of secondary amenorrhea (due to some cause other than pregnancy) is about 4% in the general population.

Symptoms associated with amenorrhea depend on the cause and may include:

  • Headache
  • Galactorrhea (breasts produce milk in a woman who is not pregnant or breast-feeding an infant)
  • Vision loss (in rare cases of pituitary tumor)
  • Marked weight gain or weight loss
  • Acne
  • Dry vagina
  • Increased hair growth in a "male" pattern (hirsutism)
  • Voice changes
  • Breast size changes
  • Cyclic pain without bleeding

Common Causes

Causes of primary amenorrhea:

  • Delay may be normal if puberty characteristics, such as breast development, are present by age 13
  • Birth defects of the female reproductive system
  • Lack of an opening in the membrane at the entrance of the vagina (hymen)
  • Problem with the hypothalamus or pituitary gland

Factors that can disrupt normal menstruation and cause secondary ammenorrhea include:

  • Drastic weight loss
  • Eating disorders
  • Pregnancy
  • Stress and anxiety
  • Drastic weight reduction
  • Significant weight gain or obesity
  • Hormonal imbalance (such as with polycystic ovarian syndrome)
  • Endocrine disorders such as thyroid disease or pituitary disease/tumor
  • Intrauterine device (IUD)
  • Too much exercise
  • Premature ovarian failure
  • Menopause (normal for women over age 45)
  • Use of birth control pills and other contraceptives
  • Uterine scarring, usually from procedures such as dilation and curettage (D and C)


Review Date: 06/16/2010
Reviewed By: David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc., and Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)