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Definition  

Menstruation, or a menstrual period, refers to the monthly process in which the uterus sheds blood and tissue to prepare for pregnancy.

Not having or missing a menstrual period is called amenorrhea. This condition is divided into two types:

  • Primary amenorrhea—when an adolescent female has not yet begun menstruation by around age 16 years
    • Most females begin menstruating between the ages 9-18, but age 12 is the average.
  • Secondary amenorrhea—when a woman who has previously menstruated misses three or more periods in a row
Menstrual Flow  
Menstrual Flow

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Causes  

The most common cause of secondary amenorrhea is pregnancy. In nonpregnant women, it may be due to a variety of factors.

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Risk Factors  

Factors that may increase the risk of amenorrhea include:

  • Dramatic weight loss (such as from extreme diets, eating disorders, or excessive exercise) or dramatic weight gain
  • Malnutrition
  • Birth defects, including lack of female reproductive organs
  • Chromosomal or hormonal abnormalities
  • Certain conditions such as thryoid disorder and pituitary tumor
  • Medications such as certain contraceptives
  • Emotional distress
  • Uterine scarring
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Symptoms  

The main symptom for primary amenorrhea is the absence of a menstrual period in a female by age 16 or older. The main symptom for secondary amenorrhea is three or more missed periods in a row in a woman who has previously had menstrual periods.

When Should I Call My Doctor?  

Call your doctor if you:

  • Have not had your first period and are aged 16 years or older
  • Miss having your period
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Diagnosis  

You will be asked about your symptoms and medical history. A physical exam will be done.

Your bodily fluids may be tested. This can be done with:

  • Blood tests
  • Urine tests

Images may be taken of your bodily structures. This can be done with:

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Treatment  

Treatment will depend on what is causing amennorhea. Examples include:

  • Weight-related cause—A healthy caloric intake and exercise routine usually restores hormonal balance and menstruation.
  • Birth defect—Surgery may be needed.
  • Hormonal irregularity—Hormanal therapy may be needed.
  • Emotional distress—Relaxation techniques, therapy, and exercise may help to decrease stress.