Abnormal Absence of Menstruation

What do doctors call this condition?

Amenorrhea

What is this condition?

In the primary form of this disorder, a woman's first menstrual period (menarche) doesn't occur until age 18. In the secondary form, a woman doesn't menstruate for at least 3 months after menarche begins.

What causes it?

Absence of menstruation is normal before puberty, after menopause, or during pregnancy and lactation. It indicates a problem at any other time. It usually results from a failure to ovulate because of hormonal problems.

Abnormal absence of menstruation may also result from lack of a uterus, a damaged endometrium (surface lining of the uterus), or from ovarian, adrenal, or pituitary gland tumors. It's common in women with problems such as depression and poor appetite. Absence of menstruation may also result from malnutrition, intense exercise, and prolonged use of oral contraceptives.

How is it diagnosed?

A history of failure to menstruate in a woman over age 18 confirms primary absence of menstruation. Secondary absence of menstruation is indicated by a change is noted in the woman's established menstrual pattern (for example, absence of menstruation for 3 months). A thorough physical and pelvic exam rules out pregnancy, as well as anatomic abnormalities that may cause false absence of menstruation (called cryptomenorrhea), in which other symptoms of menstruation occur without external bleeding.

The doctor may order diagnostic tests, including administering pure progestins, such as Depo-Provera and progesterone, to evaluate uterine function. Blood and urine studies may reveal hormonal imbalances caused by lack of ovarian response to gonadotropins, failure of gonadotropin secretion, and abnormal thyroid levels. A complete medical workup, including appropriate X-rays, laparoscopy, and a biopsy, may disclose ovarian, adrenal, and pituitary tumors.

How is it treated?

The doctor will prescribe appropriate hormone replacement therapy to reestablish menstruation. If the disorder isn't related to hormone deficiency, treatment depends on the cause. For example, if it results from a tumor, surgery is usually required.

What can a woman with absence of menstruation do?

After treatment, keep an accurate record of your menstrual cycles to aid early detection if this condition recurs