Carl R. Darnall Army Medical Center - Health Library

Absent Periods

(Absent Menses; Amenorrhea)

Definition

Menstruation, or a period, is part of a monthly cycle in women. If a women does not have or misses a period it is called amenorrhea. Types of amenorrhea include:

  • Primary—First period has not occurred by a certain age (most females have their first period between 9-18 years of age, average age is 12 years)
  • Secondary—periods were regular in the past but then 3 or more periods were missed in a row

Menstrual Flow
Menstrual Flow

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Causes  ^

Amenorrhea is most often caused by a problem with hormones. A number of hormones start changes in the body that result in a period. These hormones may be decreased by:

  • Medical conditions
  • Treatments such as medication or radiation treatment
  • Genetic disorders
  • Lifestyle extremes such as poor nutrition, excessive physical activity, or high amounts of stress

Problems may also be caused by damage to the uterus itself. This is less common.

Risk Factors  ^

Factors that may increase the risk of amenorrhea include:

  • Dramatic weight change—can occur with extreme diets, eating disorders, or excessive exercise
  • Malnutrition
  • Birth defects, including lack of female reproductive organs
  • Chromosomal or hormonal abnormalities
  • Certain medical or hormonal conditions, such as a thyroid disorder or pituitary tumor
  • Medications, such as certain contraceptives
  • Emotional distress
  • Uterine scarring

Symptoms  ^

Symptom for primary amenorrhea is:

  • Absence of a menstrual period by age 16 years in a female, who has normal sexual development

Symptom for secondary amenorrhea is:

  • Three or more missed periods in a row in a woman who has had regular periods

When Should I Call My Doctor?

Call your doctor if you:

  • Have not had your first period and are aged 16 years or older
  • Have missed your period

Diagnosis  ^

You will be asked about your symptoms and medical history. A physical exam will be done.

The doctor may check for pregnancy or changes in hormones with:

  • Blood tests
  • Urine tests

Images of related organs or glands may be taken with:

Treatment  ^

Treatment will depend on what the cause is. Examples include:

  • Weight-related amenorrhea may be completely relieved with:
    • Healthy diet
    • Balanced exercise
  • Surgery—may be needed to fix related birth defects
  • Hormone medication—may be needed to help boost hormone levels
  • Stress management—Learning tools to help you relax, therapy, and exercise
  • Surgery, radiation therapy, or medicine—if a tumor is causing the problem

Prevention  ^

Amenorrhea can not always be prevented. Steps that may help to prevent some amenorrhea include:

  • Keep a healthy level of body fat.
  • Get help for an eating disorder.
RESOURCES:

The American Congress of Obstetricians and Gynecologists
http://www.acog.org

Women's Health—Department of Health and Human Services
http://www.womenshealth.gov

CANADIAN RESOURCES:

Health Canada
https://www.canada.ca/en/health-canada.html

The Society of Obstetricians and Gynaecologists of Canada
https://sogc.org

REFERENCES:

Amenorrhea. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T116009/Amenorrhea. Updated March 14, 2016. Accessed September 12, 2017.

Amenorrhea. Family Doctor—American Academy of Family Physicians website. Available at: http://familydoctor.org/familydoctor/en/diseases-conditions/amenorrhea.html. Updated May 2017. Accessed September 12, 2017.

Current evaluation of amenorrhea. American Society for Reproductive Medicine website. Available at: http://www.asrm.org/globalassets/asrm/asrm-content/news-and-publications/practice-guidelines/for-non-members/current_evaluation_of_amenorrhea-pdfnoprint.pdf. Published 2008. Accessed September 12, 2017.

Last reviewed March 2018 by EBSCO Medical Review Board Beverly Siegal, MD, FACOG  Last Updated: 3/23/2018