Absence of Menstruation (Amenorrhoea)

What is absent menstruation?

• When menstruation does not come, it is called amenorrhea.
  • Primary amenorrhea is when a woman has never had menstrual periods.
  • Secondary amenorrhea is when menstruation keeps up, after previously bleeding
• Primary amenorrhea found when a girl of 13 years never had a period, nor has come in puberty. This means that she is also missing breast development, hairy crotch, nor received any growth spurt
• Primary amenorrhea includes girls aged 16 who have not had your period, but they have other signs of puberty (breast, hairiness, increased growth, vaginal discharge)

occurrence

• Primary amenorrhea is rare, and the condition will almost always lead to specialist referral
• If a girl has had a normal adolescence, but do not get menstruation should always think about the possibility that she may be pregnant

How is your period normal?

• Menstrual flow is controlled by a fine interplay of hormones produced in the brain (hypothalamus), in the pituitary gland (hjernevedhænget) and ovarian
• When girls approaching puberty, the brain and pituitary increase hormone production. After mature ovary know gradually that comes once in hormone production and eventually ovulate about monthly
• The sex hormones from the ovary acts on the lining of the uterus, then it grows and gets ready to receive a fertilized egg (a pregnancy)
• If there is a pregnancy, the mucosa rejected again – it is menstruation
• When menstruation does not get started in puberty, the cause is found in the genes, the brain, the pituitary gland or ovaries or abdomen. All these reasons are individually quite rare

What can be the reason?

Common causes

• late puberty
  • Is the leading cause. This is no disease, just a developmental delay. Menstruation are often come off by itself. Often parents also had late puberty
• Eating disorders ( anorexia nervosa )
  • Anorexia is a condition with disturbed self-image, resulting in that the person sees himself as a thick, even when the body weight is lower than that which is normal to the height
  • This brings anxiety to take on and extreme slimming to reduce body weight further
  • The quality of life is impaired, anxiety and depression often occur and the risk of adverse long-term effects on health is great
  • To have very restrictive eating habits (raw food, vegan) may be a type of anorexia
  • Menstruation often come back when body weight increases
• Excessive exercise
  • Young girls who train intensely, may experience missed periods. This applies especially if the diet also contains too few calories
• Pregnancy
  • Should never be overlooked as a possible cause in young girls

Rare causes

• Low metabolism (hypothyroidism)
  • Is very rare in young girls, typically occurs in middle-aged and older women
  • Typical symptoms are lack of initiative, cold intolerance, muscle pain, increased need for sleep, weight gain (usually moderate), constipation, dizziness, tingling sensations in the hands, hair loss, cloudy / rough voice
• Tumor in the pituitary gland
  • Is very rare
  • May cause hormonal changes, including lack of menstruation
• Turner Syndrome (genetic error)
  • Typical features are low altitude and that the girl did not reach puberty
  • The diagnosis can be made prenatally, at birth, but are in some cases first recognized in teens
• Powerful virginity or other strictures that prevent bleeding (hymen imperforata or vaginal aplasia)
• Lack of development of the uterus (MRKH syndrome)
• Other rare inherited conditions

• Excessive dieting and intense physical exercise should be limited
• Besides this, it is limited in what you can do yourself. It is a problem, you should talk to her doctor

• A girl of 13 years of age lacking breast development, pubic hair and the growth spurt should be examined by doctor
• A girl of 16 years of age have not got menstruation, but have breasts, pubic hair and good length growth, should also consult the doctor

• When symptoms addition to the above, requiring emergency medical contact

What does the doctor?

Medical history

The doctor will ask you questions like:

• Have you had a menstrual?
• How old was your mother when she first got menstruation? Possibly. sisters?
• How much do you train?
• How are your eating habits?
• How are you mentally?
• When did you get boobs? Was it at the same time as your classmates?
• Have you been hairs in the groin and armpit?
• Have you had abdominal pain?
• Do they in that case been monthly?
• Are there any hereditary diseases in the family?
• Have you ever been treated with cytotoxic or radiation?
• Can you smell normal, for example, the smell of coffee or perfume?

medical examination

• The physician will measure the height and weight, and to compare it with the normal growth curves
• Does breast development and hairiness downwards and forearms?
• It can feel very private being investigated on breasts and bottom, and it is normal to be shy
• The doctor will not make inquiries that you did not accept

other studies

• It may be appropriate to take the blood test to measure the amount of various hormones
• Optionally pregnancy testing
• Optionally, reference is made to the ultrasonic examination of the internal reproductive organs
• At the hospital, it will be relevant with a number of additional studies as X-ray of the skeleton, MRI of the pituitary

Referral to a specialist or hospital

• All girls aged 16 who have not had menstruation, should be referred to a gynecologist
• Girls 13 without pubertal development should be referred to a pediatrician