Call your health care provider if:

• Your daughter has never had a menstrual period and is 16 or older, or is 14 or older and shows no other signs of puberty
• You have previously menstruated but have missed 3 or more periods in a row

The first step is to rule out pregnancy. This is done with a urine or blood test. (See: Pregnancy test)

The doctor will perform a physical exam and ask questions about your medical history. Questions may include:

• 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?
  • Have you lost or gain a lot of weight?
• Other symptoms
  • What other symptoms do you have?
  • Is there breast tenderness?
  • Is there morning nausea and vomiting?
  • Is there a headache?
  • Do you have a nipple discharge (but you are 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
• Blood tests to check estradiol and testosterone hormone levels
• Thyroid function studies
• FSH (follicle stimulating hormone) test
• LH (luteinizing hormone) test
• Pelvic ultrasound or hysterosonogram
• MRI or 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 medications or birth control pills to treat the problem.

If the absent menstruation is caused by a bodywide (systemic) disorder, normal menstrual function usually returns after the primary disorder is treated. For example, if your period stopped because of a thyroid disorder, it will usually return once you start thryoid treatment.

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.

Images

Secondary amenorrhea

Primary amenorrhea

Absence of menstruation (amenorrhea)

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Menstruation Overview

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Menstruation Prevention

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)