Menstruation - absent

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Absence of menstruation (amenorrhea)

Primary amenorrhea

Secondary amenorrhea

Missed periods; Lack of menses; Periods - missed; Amenorrhea

Treatment depends on the cause.

• For amenorrhea caused by normal delay of menstruation onset, have patience until age 16. However, keep in mind that the delay is only normal if the girl displays some signs of puberty, such as breast development
• Consult your obstetrician to determine if you may be pregnant.
• For a missed period caused by drastic weight loss or obesity, proper diet is recommended.
• For a missed period resulting from excessive exercise, cut back to a more conservative workout program.

• You have never had a menstrual period and you are age 16 or older
• You have previously menstruated but have missed 3 or more periods in a row

The first step is to rule out pregnancy. This is done with a urine or blood test.

Next, the doctor will perform a physical exam and ask questions about your medical history, which may include the following:

• Menstrual history
  • Are you a woman presently in a menstruating age range (over 12 and under 55)?
  • Are you sexually active?
  • Do you use birth control? What type?
• Quality
  • Was the previous menstrual period a normal amount?
  • Are the menses absent or decreased?
  • Do you usually have regular periods?
• Time pattern
  • When was your last menstrual period?
  • At what age did you have your first menstrual period?
  • Have you ever had normal periods?
• Aggravating factors
  • What medications do you take?
  • How much do you exercise?
• Other symptoms
  • What other symptoms are also present?
  • Is there breast tenderness?
  • Is there morning nausea and vomiting?
  • Is there a headache?
  • Is there a nipple discharge (and not breast feeding)?
  • Is there vision loss or change in vision?
  • Is there an unintentional weight gain?
  • Is there an unintentional weight loss?
  • Is there hair growth in a male pattern?
  • Is there excessive anxiety?

Tests that may be performed include:

• Progestin withdrawal (take a hormonal medicine for 7 to 10 days to trigger bleeding)
• Prolactin level
• Serum hormone levels such as testosterone levels
• Thyroid function studies , including TSH ( thyroid stimulating hormone
• Pregnancy test ( serum HCG )
• FSH ( follicle stimulating hormone level)
• LH ( luteinizing hormone level)
• Pelvic ultrasound
• CT scan of the head may be done if a pituitary tumor is suspected