(Absent Menses; Amenorrhea)
Menstruation, or a menstrual period, refers to the monthly process in which the uterus sheds blood and tissue to prepare for pregnancy.
Not having or missing a menstrual period is called amenorrhea. This condition is divided into two types:
Primary amenorrhea—when an adolescent female has not yet begun menstruation by around age 16 years
- Most females begin menstruating between the ages 9-18, but age 12 is the average.
- Secondary amenorrhea—when a woman who has previously menstruated misses three or more periods in a row
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The most common cause of secondary amenorrhea is pregnancy. In nonpregnant women, it may be due to a variety of factors.
Factors that may increase the risk of amenorrhea include:
- Dramatic weight loss (such as from extreme diets, eating disorders, or excessive exercise) or dramatic weight gain
- Birth defects, including lack of female reproductive organs
- Chromosomal or hormonal abnormalities
- Certain conditions such as thryoid disorder and pituitary tumor
- Medications such as certain contraceptives
- Emotional distress
- Uterine scarring
The main symptom for primary amenorrhea is the absence of a menstrual period in a female by age 16 or older. The main symptom for secondary amenorrhea is three or more missed periods in a row in a woman who has previously had menstrual 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
- Miss having your period
You will be asked about your symptoms and medical history. A physical exam will be done.
Your bodily fluids may be tested. This can be done with:
- Blood tests
- Urine tests
Images may be taken of your bodily structures. This can be done with:
Treatment will depend on what is causing amennorhea. Examples include:
- Weight-related cause—A healthy caloric intake and exercise routine usually restores hormonal balance and menstruation.
- Birth defect—Surgery may be needed.
- Hormonal irregularity—Hormanal therapy may be needed.
- Emotional distress—Relaxation techniques, therapy, and exercise may help to decrease stress.
- Pituitary tumor—Surgery, radiation therapy, or medication may be needed.
Amenorrhea may or may not be preventable, depending on the cause. Follow these general guidelines to prevent amenorrhea:
- Maintain an appropriate level of body fat.
- Get help for an eating disorder.
- Treat conditions that can lead to amenorrhea, such as polycystic ovary syndrome, pituitary tumor, and hypothyroidism.
Women’s Health—US Department of Health and Human Services http://www.womenshealth.gov
The Society of Obstetricians and Gynaecologists of Canada http://www.sogc.org
Updated April 7, 2014. Accessed August 8, 2014.
Amenorrhea. Family Doctor—American Academy of Family Physicians website. Available at:
Updated February 2014. Accessed August 8, 2014.
Current evaluation of amenorrhea. American Society for Reproductive Medicine website. Available at:
Accessed August 8, 2014.
Last Updated: 8/8/2014