Absent menses
Key points
- This condition is the absence of any menstrual flow in a woman who has never menstruated by the age of 16.
- Most girls begin menstruating between ages 9 and 18, with an average around 12 years old.
- Primary amenorrhea caused by developmental abnormalities (which may result when the parts of the female reproductive system did not form properly before birth) may require hormonal supplementation, surgery, or both.
- Overall the outlook is good, depending on the cause of the amenorrhea.
Alternative names
Amenorrhea - primary; Primary amenorrhea; No periods; Absent periods; Absent menses
Definition
This condition is the absence of any menstrual flow in a woman who has never menstruated by the age of 16.
Causes, incidence, and risk factors
Most girls begin menstruating between ages 9 and 18, with an average around 12 years old. Primary amenorrhea is not considered to have occurred until a girl is beyond age 16, if she has undergone other normal changes that occur during puberty. Primary amenorrhea may occur with or without other signs of puberty.
There are many possible causes of primary amenorrhea:
- Drastic weight reduction (from poverty, fad dieting, Anorexia nervosa, bulimia, very strenuous exercise, or other cause)
- Malnutrition
- Extreme Obesity
- Chronic (long term) illnesses
- Genital abnormalities present since birth (absence of the uterus or vagina, vaginal septum, cervical stenosis, imperforate hymen)
- Gonadal dysgenesis
- Hypoglycemia
- Hypothyroidism and Hyperthyroidism
- Cystic fibrosis
- Cushing's disease
- Polycystic ovarian disease
- Chromosomal abnormalities such as Turner's syndrome (XO) or Sawyer's syndrome (XY)
- Hypogonadotropic hypogonadism
- Hyperprolactinemia
- Testicular feminization
- True hermaphroditism
- Adrenogenital syndrome
- Congenital heart disease (cyanotic)
- Congenital adrenal hyperplasia
- Craniopharyngioma, Pituitary tumors, ovarian tumors, adrenal tumors
- Prader-Willi syndrome
- Pregnancy
Primary amenorrhea in the United States occurs in less than 0.1% of girls.
Signs and tests
- Physical examination and medical history
Frequently asked questions
What is absent menses?
This condition is the absence of any menstrual flow in a woman who has never menstruated by the age of 16.
What are the risk factors for absent menses?
Most girls begin menstruating between ages 9 and 18, with an average around 12 years old. Primary amenorrhea is not considered to have occurred until a girl is beyond age 16, if she has undergone other normal changes that occur during puberty. Primary amenorrhea may occur with or without other signs of puberty.
What are the symptoms of absent menses?
- Physical examination and medical history
- Urine pregnancy test
- Progesterone withdrawal
- Chromosome analysis
- Serum chemistry (serum gonadotropin) o LH o FSH o Prolactin o TSH o T3 and T4
- Urine chemistry, 17-ketosteroids
- Head CT
- Head MRI scan
- Ultrasound, pelvic region
- Laparoscopy
How is absent menses treated?
Treatment depends on the cause of the amenorrhea. Primary amenorrhea caused by developmental abnormalities (which may result when the parts of the female reproductive system did not form properly before birth) may require hormonal supplementation, surgery, or both. Pituitary tumors, located in the brain, are usually treated with bromocriptine, a drug that inhibits the abnormally high prolactin secretion caused by these tumors. Surgical removal may also be necessary. Radiation therapy is usually reserved for situations in which other medical or surgical treatment regimens are not successful. In any case, support and counseling for the patient and family is necessary.
Written and revised by
Gerald Hurowitz, M.D.
Our doctors write and review articles for accuracy and keep them up to date.
health.am provides general information, not medical advice. Always consult a qualified health professional about your own health.