Amenorrhea

What is amenorrhea?

Amenorrhea is a menstrual condition in which a person has not started having a menstrual period or has stopped having a menstrual period.

There are two types of amenorrhea:

• Primary amenorrhea is when menstruation has not started by age 15.
• Secondary amenorrhea is when regular periods begin and then they stop for more than three months.

Often, when someone first starts getting their period, they do not come entirely regularly every month. Once periods do become regular, they should continue to come regularly. If your teenager has missed 3 periods in a row after having regular periods, or if they are 15 and have not had a period yet, it is important to contact their health-care provider to make an appointment to get checked out.

What causes amenorrhea

Menstruation may stop for several reasons including the following:

• Pregnancy: If a person has had penile-vaginal sex, amenorrhea could mean that they are pregnant.
• Contraception (birth control): Some forms of birth control, such as intrauterine devices, implants, injectable contraception and continuous pills, may cause a person to miss their period. This is a normal side effect of these forms of birth control.
• Medications: Some medications and supplements may cause amenorrhea so it is important that you or your teenager tell their health-care provider about all medications, supplements and/or herbs they may be taking.
• Weight change: If a person has gained or lost a significant amount of weight, they may skip a period or not have periods. Weight changes can be caused by chronic illness, stress or not eating properly, disordered eating or an eating disorder such as anorexia nervosa or bulimia nervosa.
• Excessive exercise: Sometimes athletes or those who exercise a lot can have missed periods because their weight is too low or they are not taking in enough nutrition.
• Polycystic ovarian syndrome (PCOS) : This is a hormonal disorder that can affect ovulation and cause missed periods.
• Underactive thyroid (hypothyroidism) or overactive thyroid (hyperthyroidism).
• Congenital anomalies: A congenital anomaly, or birth defect, of the reproductive tract could include a vaginal obstruction or an underdeveloped or absent uterus. Although these anomalies are rare, a health-care provider may recommend an ultrasound to check that the reproductive tract is developed. Some genetic conditions, such as Turner syndrome, can be associated with amenorrhea.
• Stress: Significant stress can cause a person to miss their period. This can be because of life stress, such as stress about school, family issues or friends, or physical stress caused by illness or injury.

How is amenorrhea diagnosed?

Your teenager’s health-care provider will want to understand why they are not having periods.

First, they will ask your teenager about their medical history, menstruation, sexual activity, exercise and weight. They will also do a physical exam. In some cases, the health-care provider may need to do a pelvic exam or ultrasound to check that the reproductive organs all look healthy. Blood tests may also be necessary to check hormone levels.

How is amenorrhea treated?

Treatment of amenorrhea will depend on what the cause is, your teenager’s age, and other health factors. Treatments may involve either medications or lifestyle changes or both.

If amenorrhea is caused by issues with hormones, your teenager may be referred to an endocrinologist, a doctor who specializes in hormones, for treatment. If the reproductive organs are not working properly or your teenager is diagnosed with congenital anomalies, they may be referred to a gynaecologist, a doctor who specializes in female reproductive health.