Gerald Hurowitz, M.D.·Published 27 April 2005·3 min read
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)
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
Treatment
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. This will address specific concerns and provide guidance regarding anticipated sexual development.
For women who do not have other reproductive abnormalities, work up for amenorrhea is delayed until after age 16.
If the condition is caused by systemic disease, treatment of the disease may allow menstruation to begin.
Expectations (prognosis)
Overall the outlook is good, depending on the cause of the amenorrhea. If the amenorrhea is caused by one of the following conditions, there is a good possibility of correcting the amenorrhea through medication, lifestyle change, or surgery:
Normal delay of onset (up to age 14 or 15)
Drastic weight reduction (resulting from poverty or fad dieting)
If the amenorrhea cannot be corrected, it is sometimes possible to create a pseudomenstruation with medications to help the young woman feel more like her friends or family.
Complications
Emotional distress or crisis about being different from friends or family can occur.
Calling your health care provider
Call your health provider if your daughter is older than age 16 and has not yet begun menstruating.
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