Medical Health Encyclopedia

Menstruation - absent

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Absence of menstruation (amenorrhea) Primary amenorrhea Secondary amenorrhea

Overview Treatment

Menstruation - absent

Definition:

The absence of menstrual flow may be primary (menstruation fails to begin before age 16) or secondary (menstruation begins at the appropriate age, but later ceases for 6 or more months in the absence of normal causes such as pregnancy, lactation, or menopause).

Alternative Names:
Missed periods; Lack of menses; Periods - missed; Amenorrhea

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Considerations:

Many perfectly normal females begin to menstruate later than most (the median age is 12.8).

Pregnancy is often the first thought when a period is missed, but there are many reasons for having a late period.

The incidence of primary amenorrhea in the United States is less than 1%. The incidence of secondary amenorrhea (due to some cause other than pregnancy) is about 4% in the general population.

Increased risk is associated with extreme and prolonged exercise (particularly without adequate conditioning), body fat content less than 15% to 17%, extreme obesity, and taking hormonal supplements.

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

• Headache
• Galactorrhea (breasts produce milk in a woman who is not pregnant or breast-feeding an infant)
• Visual loss (in rare cases of pituitary tumor)
• Marked weight gain or weight loss
• Dry vagina
• Increased hair growth in a "male" pattern (hirsutism)
• Voice changes
• Breast size changes

Common Causes:

PRIMARY AMENORRHEA

• Normal delay of onset (up to age 16)
• Lack of an opening in the membrane at the entrance of the vagina (hymen)
• Drastic weight reduction
• Congenital abnormalities of the genital system
• Chromosomal abnormalities
• Extreme obesity

SECONDARY AMENORRHEA

• Pregnancy
• Anxiety over pregnancy may cause a missed period, thereby increasing the anxiety even further
• Drastic weight reduction
• Vigorous athletics
• Obesity
• Emotional distress
• Menopause (normal for women over age 45)
• Endocrine disorders such as thyroid disease or pituitary disease/tumor
• Drugs such as busulfan, chlorambucil, cyclophosphamide, oral contraceptives, phenothiazines, and non-oral contraceptives (such as Norplant and Depo-Provera)
• Dilation and curettage (D and C)

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