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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 or absent.

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 be done: 

  • Pelvic ultrasound to determine any abnormalities of the reproductive system

  • Blood tests of various hormone levels

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

Online Medical Reviewer: Burd, Irina, MD, PhD
Online Medical Reviewer: Freeborn, Donna, PhD, CNM, FNP
Date Last Reviewed: 5/1/2017
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