It's That Time of the Month, but Something Seems Wrong

Dr. Jonathan Trager


There are two types of amenorrhea, or absence of menstruation:

Primary amenorrhea occurs when a girl with normal changes of puberty (such as breast development and pubic hair growth) doesn't get her first period by age 16.


If that applies to you, see your doctor. Different problems can cause primary amenorrhea including genetic problems, excessive exercise and the eating disorder anorexia nervosa.


Secondary amenorrhea occurs when a girl who has had regular cycles for at least six months, or who got her first period at least 18 months before, stops getting her periods for three cycle lengths.


Causes include:

  • Pregnancy -- This is one of the first things your doctor will check for.
  • Medical conditions -- Such as thyroid problems or elevation of a hormone called prolactin.
  • Stress -- Heavy emotional stress can cause you to miss periods.
  • Anorexia nervosa -- Being significantly underweight can make your periods stop.
  • Excessive exercise -- This can also cause your periods to stop by altering hormone levels.
  • Polycystic Ovary Syndrome -- PCOS is a group of problems caused by excess androgens, a type of hormone.


If you have secondary amenorrhea your doctor will give you a complete checkup, which may include a pelvic exam, and order lab tests to check for medical problems and pregnancy.


Treatment options include hormonal medications to make you have a period and birth control pills to keep your periods regular. Birth control pills contain estrogen and progesterone hormones, which will make your periods occur regularly. These may be prescribed even if you are not sexually active.


Your doctor may perform a pelvic ultrasound if he or she suspects you have a genital abnormality.


Abnormal Vaginal Bleeding
The most common cause of abnormal vaginal bleeding in adolescents is dysfunctional uterine bleeding (DUB). A lack of regular ovulation, which is common in teen-agers, causes DUB. Lack of regular ovulation leads to excessive thickening of the inner lining of your uterus, which can shed irregularly and cause excessive, prolonged or irregular bleeding.

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