Amenorrhea in Teens
What is amenorrhea?
Amenorrhea is a menstrual condition characterized by absent menstrual periods for
more than 3 monthly menstrual cycles. Amenorrhea may be primary or secondary:
Primary amenorrhea. Menstruation never starts at puberty. This may be lifelong.
Secondary amenorrhea. This is due to some physical cause and usually starts later
in life. Once normal menstrual periods become increasingly abnormal and irregular
What causes amenorrhea?
There are several possible causes of amenorrhea, including:
Pregnancy. Females no longer ovulate when they are pregnant. Menstruation ceases temporarily.
Ovulation abnormality. Ovulation abnormalities are usually the cause of very irregular
or frequently missed menstrual periods.
Birth defect, anatomical abnormality, or other medical condition. If a young woman
has not started to menstruate by age 16, your doctor may suspect a birth defect, anatomical
abnormality, or other medical condition.
Eating disorder. Females with anorexia or bulimia often have amenorrhea because their
body weight is too low to sustain a pregnancy. The reproductive system "shuts down"
because it is severely malnourished.
Overexercise or strenuous exercise. Many young female athletes in training do not
have a menstrual cycle due to low body fat content.
Thyroid disorder. In many cases, an underactive thyroid gland or an overactive thyroid
gland is responsible for the absent menstrual cycles.
Obesity. Females who are obese often have amenorrhea as a result of excess fat cells
that interfere with ovulation.
Pituitary adenoma. A tumor that forms in the brain that may interfere with the normal
functions of the hormones. This can prevent ovulation and cause loss of periods.
How is amenorrhea diagnosed?
Your daughter's gynecologist or other healthcare provider will ask about her medical
history, including growth and development, family history, and do a complete physical
exam including a pelvic exam. The healthcare provider may need to rule out other menstrual
disorders, medical conditions, or medicines that may be causing or making the condition
worse. A diagnosis of amenorrhea requires that a female miss at least 6 menstrual
cycles in a row, without being pregnant. Young women who haven't had their first menstrual
period by age 15 should be evaluated. Making an early diagnosis and starting treatment
as soon as possible is important.
Depending on the results of your teen's history and physical, one of these tests may
How is amenorrhea treated?
Treatment for amenorrhea may include:
Progesterone supplements (hormone treatment)
Oral birth control pills
Treatment of underlying cause through medicines or possibly surgery
Dietary changes (to include consuming more calories and fat)
Calcium supplementation to reduce bone loss