Amenhorrhea, Primary

General Illness Information

Common Name:
AMENHORRHEA, PRIMARY

Medical Term: None specified

Description: Complete absence of menstruation in a young woman who is at least 16 years old. It is a rare disorder as over 95% of girls have their first menstrual period by age 15.

Causes: Usually unknown.

  • Possible causes include:
  • Delayed puberty (i.e. hormonal causes);
  • Congenital abnormalities, such as the absence or abnormal formation of female organs (vagina, uterus, ovaries);
  • Intact hymen (membrane covering the vaginal opening) that has no opening to allow passage of menstrual flow;
  • Disorders (tumors, infections or lack of maturation) of the endocrine system;
  • Chromosome disorders (Turner’s syndrome – in which the cells contain only one X chromosome instead of the usual two);
  • Systemic disease.

Prevention:

  • Don’t use drugs unless prescribed by your physician.
  • Reduce athletic activities if they are too strenuous.
  • Obtain medical treatment for any underlying disorder.
  • Maintain proper nutrition and body weight.

Signs & Symptoms

Lack of menstrual periods after puberty. Most girls begin menstruating by age 14, average age is 12 years and 8 months.

Risk Factors

  • Stress
  • Use of medications, including oral contraceptives, anticancer drugs, barbiturates, narcotics, cortisone
  • Excessive exercise
  • Family history to start menstruation late
  • Excessive dieting or weight loss

Diagnosis & Treatment

General Measures:

  • Diagnostic tests may include:
  • A thorough history and physical examination and to determine the development of secondary sexual characteristics
  • Laboratory studies of blood samples to check for hormone levels such as prolactin, estrogen, follicle stimulating hormone, luteinizing hormone plus thyroid and adrenal function studies
  • X-rays and CT scan of the head to rule out pituitary tumor
  • Ultrasound of the abdomen to look for tumors of the ovary or the adrenal glands
  • Psychotherapy or counseling, if amenorrhea is stress-related or results from eating disorders

Medications:

  • You may be prescribed progesterone (hormone) treatment to induce bleeding. If bleeding begins when progesterone is withdrawn, the reproductive system is functioning. This also indicates that pituitary disease is unlikely. If progesterone withdrawal does not induce bleeding, gonad stimulants such as clomiphene or gonadotropins may be used for the same purpose.
  • Treatment usually involves hormone replacement therapy. Treatment for amenorrhea not related to hormone deficiency depends on the cause.
  • Surgery (minor) to create an opening in the hymen, if necessary.

Activity:

No restrictions. Exercise regularly, but not to excess. Sleep at least 8 hours every night.

Diet:

  • Eat 3 well-balanced meals a day.
  • If you are overweight or underweight, get medical advice about diets. Don’t try to lose weight by crash dieting.

Possible Complications :

  • Psychological distress about sexual development.
  • Inability to conceive

Prognosis

The absence of menstruation is not a health risk in itself, but that it should be identified and treated. Amenorrhea is usually curable with hormone treatment or by treatment of the underlying cause. Treatment may be delayed to age 18 unless the cause can be identified and treated safely. Causes that sometimes cannot be corrected include chromosome disorders.

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