Main AHCA Website

AHCA’s main website for information on Medicaid, Health Quality Assurance and the Florida Center for Health Information and Policy Analysis.

Go >

Florida Health Information Network

This website provides information and resources relating to AHCA’s initiatives for Health Information Technology and Health Information Exchange.

Go >


FloridaHealthFinder.gov

Provides health education and information to compare and locate health care providers in Florida to make well-informed health care decisions.

Go >
AHCA Network of Websites

Health Education


Health Encyclopedia

Search the Health Encyclopedia

Amenorrhea - primary

Definition

Amenorrhea is the absence of menstruation. Menstruation is a woman's monthly period.

Primary amenorrhea is when a girl has not yet started her monthly periods, and she:

  • Has gone through other normal changes that occur during puberty
  • Is older than 15

Alternative Names

Primary amenorrhea; No periods - primary; Absent periods - primary; Absent menses - primary; Absence of periods - primary

Causes

Most girls begin menstruating between ages 9 and 18, with an average of around 12 years old. Primary amenorrhea typically occurs when a girl is older than 15, if she has gone through other normal changes that occur during puberty. Primary amenorrhea may occur with or without other signs of puberty.

Being born with incompletely formed genital or pelvic organs can lead to primary amenorrhea. Some of these defects include:

  • Blockages or narrowing of the cervix
  • Hymen that has no opening
  • Missing uterus or vagina
  • Vaginal septum (a partition that divides the vagina into two sections)

Hormones play a big role in a woman's menstrual cycle. Hormone problems can occur when:

  • Changes occur to the parts of the brain where hormones that help manage the menstrual cycle are produced
  • The ovaries are not working correctly

Either of these problems may be due to:

  • Anorexia (loss of appetite)
  • Chronic or long-term illnesses, such as cystic fibrosis or heart disease
  • Genetic defects or disorders
  • Infections that occur in the womb or after birth
  • Other birth defects
  • Poor nutrition
  • Tumors

In many cases, the cause of primary amenorrhea is not known.

Symptoms

A female with amenorrhea will have no menstrual flow. She may have other signs of puberty.

Exams and Tests

The doctor will perform a physical exam and ask questions about your medical history. A pregnancy test will be done.

Blood tests may include:

Other tests that may be done include:

Treatment

Treatment depends on the cause of the missing period. Primary amenorrhea that is caused by birth defects may require hormone medications, surgery, or both.

If the amenorrhea is caused by a tumor in the brain:

  • Medications may shrink certain types of tumors.
  • Surgery to remove the tumor may also be needed.
  • Radiation therapy is usually only done when other treatments have not worked.

If the condition is caused by a body-wide disease, treatment of the disease may allow menstruation to begin.

If the amenorrhea is due to anorexia or too much exercise, periods will often begin when the weight returns to normal or the exercise level is decreased.

If the amenorrhea cannot be corrected, medicines can sometimes create a menstrual-like situation. Medicines can help the woman feel more like her friends and female family members. They can also protect the bones from becoming too thin (osteoporosis).

Outlook (Prognosis)

The outlook depends on the cause of the amenorrhea and whether it can be corrected with treatment or lifestyle changes.

Periods are not likely to start on their own if the amenorrhea was caused by one of the following conditions:

  • Congenital defects of the upper genital system (uterus, hymen, and other structures inside the genitals)
  • Craniopharyngioma (a tumor near the pituitary gland at the base of the brain)
  • Cystic fibrosis
  • Genetic disorders

You may have emotional distress because you feel different from friends or family. Or you may worry that you might not be able to have children.

When to Contact a Medical Professional

Call your health care provider if your daughter is older than 15 and has not yet begun menstruating, or if she is 14 and shows no other signs of puberty.

References

Bulun SE. The physiology and pathology of the female reproductive axis. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology, 12th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 17.

Lobo RA. Primary and secondary amenorrhea and precocious puberty: etiology, diagnostic evaluation, management. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 38.

Styne DM, Grumbach MM. Puberty, ontogeny, neuroendocrinology, physiology, and disorders. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology, 12th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 25.

Review Date:6/13/2014
Reviewed By:Cynthia D. White, MD, Fellow American College of Obstetricians and Gynecologists, Group Health Cooperative, Bellevue, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997-A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

adam.com

The Agency for Health Care Administration (Agency) and this website do not claim the information on, or referred to by, this site is error free. This site may include links to websites of other government agencies or private groups. Our Agency and this website do not control such sites and are not responsible for their content. Reference to or links to any other group, product, service, or information does not mean our Agency or this website approves of that group, product, service, or information.

Additionally, while health information provided through this website may be a valuable resource for the public, it is not designed to offer medical advice. Talk with your doctor about medical care questions you may have.

We Appreciate Your Feedback
1. Did you find this information useful?
         Yes
         No

2. Would you recommend this website to family and friends?
         Yes
         No