Overview Of Absence Of Periods – Primary
The absence of monthly periods (menstrual cycle) is referred to as amenorrhea.
Primary amenorrhea is when monthly periods have not yet begun, and the person:
- Has gone through other normal changes that occur during puberty
- Is older than 15
Commonly Associated With
Absent menses, Absent periods, Absence of periods, or No periods
Causes Of Absence Of Periods – Primary
Most people begin their menstrual cycles between the ages of 9 and 18. The average for the start of the cycles is around 12 years old. If no periods have occurred when the person is older than 15, diagnostic testing may be necessary. The need is more urgent if they have already gone through other normal changes that occur during puberty.
Being born with incompletely formed pelvic or genital organs sometimes leads to a lack of menstrual cycles. Some of these abnormalities can include:
- A vaginal septum (a wall that divides the vagina into 2 sections)
- A hymen without an opening
- A blockage or narrowing of the cervix
- A missing uterus or a lack of a vagina altogether
Hormones can play a big role in the menstrual cycle. Hormonal abnormalities can occur when:
- The ovaries are not functioning as they should
- Changes have occurred to the parts of the brain that normally produce hormones that help manage the menstrual cycle
Either of these problems may be due to:
- Anorexia (loss of appetite)
- Chronic or long-term illnesses, such as cystic fibrosis or heart disease
- Genetic defects or disorders
- Infections that occur in the womb or after birth
- Other birth defects
- Poor nutrition
In many cases, the cause of primary amenorrhea is unknown.
Symptoms Of Absence Of Periods – Primary
A female with amenorrhea will have no menstrual flow. She may have other signs of puberty.
Treatment Of Absence Of Periods – Primary
Treatment depends on the cause of the missing period. Lack of periods that stem from birth defects may require hormone medicines, surgery, or both.
If a tumor in the brain is causing the amenorrhea:
- Medications can reduce the size of certain types of tumors
- Surgery to remove the tumor can also be necessary
- When other treatments are not working, radiation therapy is typically the next step.
If the cause of amenorrhea is a systemic disease of some sort, treating of the disease will potentially allow menstruation cycles to begin.
When the cause of the amenorrhea is bulimia, anorexia, or too much exercise, menstrual cycles often begin when the person’s weight returns to normal or the exercise levels decrease to more healthy levels.
If the amenorrhea cannot be corrected, hormonal medications is sometimes used.
Medication to treat amenorrhea can help the person feel as if they fit in with other women in their lives, if they wish. Most importantly, though, they can also protect the person’s bones from becoming too thin (osteoporosis).
The prognosis of this issue depends on the cause of the amenorrhea and if lifestyle changes or a variety of treatments will correct it.
Menstrual cycles are not likely to start on their own when the cause of amenorrhea is one of the following conditions:
- Genetic disorders
- Craniopharyngioma (a tumor located near the pituitary gland at the base of the brain)
- Birth defects of the genital or pelvic organs
- Cystic fibrosis
The patient may experience emotional distress if they feel different from friends or family due to their amenorrhea. Or, they may worry about their future fertility, if having children interests them.
When to Contact a Medical Professional
Parents should contact a health care provider if their child is older than 15 and has not yet begun menstruating, or if they are 14 and shows no other signs of puberty.
Exams and Tests
A health care provider can perform a physical exam to check for birth defects of the vagina or uterus, if necessary.
The Provider may ask questions about:
- Their eating habits
- Medications or supplements they may be taking
- Their medical history
- How much exercise they have on a daily or weekly basis
The health care provider may test for pregnancy if they feel it is necessary.
Blood tests are sometimes done to measure different hormone levels, and these tests can include:
- Serum progesterone
- T3 and T4
- 17 hydroxyprogesterone
- Serum testosterone level
Other tests that are sometimes done include:
- A head MRI scan or head CT scan to search for possible brain tumors
- Chromosomal or genetic testing
- A pelvic ultrasound to search for birth defects