Menstruation, absent
Alternative names:
missed periods; lack of menses; periods, missed; amenorrhea
Home care:
Treatment depends on the cause. For amenorrhea caused by
normal delay of menstruation onset, have patience until age
16. For a missed period caused by pregnancy,
consult your obstetrician to confirm pregnancy. For a missed
period caused by drastic weight
loss or obesity,
proper diet is recommended. For a missed period resulting
from excessive exercise,
use moderation and cut back to a more conservative program.
Call your health care provider if:
- there is no satisfactory explanation for a missed period.
What to expect at your health care provider's office:
The medical history will be obtained and a physical
examination performed.
A complete health history will be obtained including a menstrual
history. Questions may include:
- menstrual history
- Are you a woman presently in a menstruating age (over
12 and under 55)?
- Are you sexually active?
- Do you use birth
control? What type?
- quality
- Was the previous menstrual period a normal amount?
- Are the menses absent or decreased?
- Do you usually have regular periods?
- time pattern
- When was your last menstrual period?
- At what age did you have your first menstrual period?
- Have you ever had normal periods?
- aggravating factors
- What medications do you take?
- How much do you exercise?
- other symptoms
A physical examination, including a pelvic examination, will
be performed. In patients with secondary
amenorrhea, physical and pelvic examinations must rule
out pregnancy before
diagnostic testing begins. The patient may be encouraged to
discuss her fears and, if indicated, may be referred for psychological
counseling.
Diagnostic tests that may be performed include:
Intervention:
Treatment depends on the cause of the amenorrhea. If it is
caused by another systemic
disorder, normal menstrual function usually returns after
the primary disorder is treated. For example, if the primary
disorder is hypothyroidism,
then amenorrhea will be cured when the thyroid
disorder is treated with thyroid supplements.
Pituitary tumors are
usually treated with bromocriptine, a drug that inhibits prolactin
secretion. Surgical removal may also be suggested. Radiation
therapy is usually reserved for situations where other
medical or surgical treatment regimens are not successful.
Hormonal supplements are commonly utilized for those women
who do not bleed in response to the progestin challenge test.
Daily estrogen supplements are given in conjunction with intermittent
progestin for 10 to 14 days per month every 1 to 3 months.
Women who bleed in response to the progestin challenge test
are anovulatory--they do not menstruate because they do not
ovulate. This common cause of amenorrhea is treated by inducing
ovulation with medication such as clomiphene citrate (Clomid)--but
only if the patient desires pregnancy.
Young women with primary
amenorrhea, found to be caused by developmental abnormalities,
may require hormonal supplementation, surgery, or both. In
any case, psychosocial support and counseling for the patient
and family is necessary to address specific concerns and provide
guidance regarding anticipated sexual development.
After seeing your health care provider:
You may want to add a diagnosis related to amenorrhea to your
personal medical record.
Update Date: 02/09/00
Updated by: J. Gordon Lambert, MD, Associate Medical Director,
Utah Health Informatics and adam.com
editorial
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