Children's Hospital Colorado

Amenorrhea in Girls and Teens

What is amenorrhea?

Amenorrhea is the absence of menstrual periods. Primary amenorrhea refers to when a girl has not started her period within three years of breast development or has not experienced a period by age 15. Secondary amenorrhea is defined as no menstrual period for three cycles after already having monthly menstrual periods, or no menstruation for six months if a girl was already experiencing irregular menstrual cycles.

Absent periods can cause stress and confusion for young girls and their families. Children's Hospital Colorado provides the medical expertise in pediatric and adolescent gynecology to ease your stress.

What causes amenorrhea?

Many factors can cause amenorrhea. In girls who have never had a period before, it is important to make sure that the female reproductive structures are normal. A blockage or absence of any part of the vagina or uterus can prevent the onset of periods.

Other amenorrhea causes include weight gain or loss, physical and emotional stress, highly competitive athletics, endocrine conditions such as polycystic ovarian syndrome (PCOS), high prolactin level, adrenal problems, thyroid conditions and chronic medical concerns like diabetes and celiac disease. Primary ovarian insufficiency, a condition that causes the ovaries to work abnormally, is another cause of amenorrhea.

Who gets amenorrhea?

Amenorrhea occurs for many different reasons and has many potential risk factors. Common risk factors include:

  • A congenital anomaly in the kidneys or urologic system
    • This increases the chances of having an anomaly of the reproductive system, which can cause absent menstruation.
  • Significant weight loss or gain
  • Polycystic ovarian syndrome (PCOS)
  • Competitive athletics

What are the signs and symptoms of amenorrhea in young women?

The two primary signs of amenorrhea are:

  • No menstrual period by age 15, commonly referred to as primary amenorrhea
  • No menstruation for more than three cycles in a row, commonly referred to as secondary amenorrhea

Other signs and symptoms depend on the cause of amenorrhea, and include:

  • Girls with a blockage in their reproductive system may have several days of pain and cramping each month even though they have never had a menstrual period.
  • In addition to irregular periods, teens with PCOS may experience weight gain, acne and excessive hair on their face and body.
  • Young women with primary ovarian insufficiency may have much lighter and skipped periods, or no periods at all.

How is amenorrhea diagnosed in girls and teens?

Diagnosis starts with a careful medical history, a physical exam and lab tests to detect any potential underlying hormone issues. In some cases, a pelvic exam and/or ultrasound is necessary.

Our care team will determine the best approach for each patient.

What to expect from an exam for amenorrhea

Determining the underlying cause of absent periods is important, and our team works to do just that. The most important aspects of a correct amenorrhea diagnosis are a detailed medical history, basic physical exam and lab testing.

Our care team will ask a number of questions relating to common amenorrhea symptoms such as menstrual cycles, weight loss and family medical history. A physical exam will include comparing weight and height to growth charts and checking other developmental markers. Lab tests are typically used to detect pregnancy or particular hormones. When necessary, we will perform an X-ray to establish bone age or a pelvic ultrasound to evaluate the uterus and ovaries.

If your daughter has never had a period before, it is important to look at the outside of the vagina. A complete, internal pelvic exam is not typically necessary.

Amenorrhea treatment

Amenorrhea treatment varies depending on its cause. Our multidisciplinary care team works together to determine the best treatment plan for your family. Potential treatment approaches are listed below:

  • We treat girls with PCOS with medications to regulate their period and to help with any other concerns, such as acne. Our care team also works closely with your family to help your daughter make healthy choices about food and exercise.
  • When weight gain or loss is the cause of amenorrhea, we work to find the right nutritional support for your daughter to help regulate menstrual cycles. In addition, we may recommend medications for irregular periods, or monitor her closely to see if periods normalize based on nutritional support.
  • If there is a structural cause of amenorrhea, such as a blockage in the reproductive system, we will discuss surgical and medical options with a team of doctors who treat both common and rare conditions.

Our gynecologists are part of the Polycystic Ovarian Syndrome Clinic at Children's Colorado, which is the only clinic of its kind in the Rocky Mountain region. Specialists at this clinic include endocrinologists, gynecologists, dermatologists, psychologists and lifestyle experts. We coordinate with this team on any issue affecting menstrual concerns.

Why choose Children's Colorado for amenorrhea treatment?

We understand that amenorrhea typically occurs at a time when girls are experiencing a lot of change and can be very stressful. Our board-certified pediatric and adolescent gynecologists have the specialized training and experience in reproductive health issues to put your family at ease. We will carefully explain amenorrhea, discuss the various options for treatment and support your family with follow-up visits and consultation with our colleagues in other specialties as needed.

We work with a multidisciplinary team to ensure your daughter is receiving the best care for her particular symptoms. Absent menstruation in girls and adolescents is unique to this particular age, so you want our care team that specializes in child and adolescent care.

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