Amenorrhea

What are the signs and symptoms of amenorrhea?

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:

• A blockage in the reproductive system may cause several days of pain and cramping each month even though there is an absence of a menstrual period.
• In addition to irregular periods, teens with PCOS may experience weight gain, acne and excessive hair on their face and body.
• Teens or adolescents with primary ovarian insufficiency may have much lighter and skipped periods, or no periods at all.

How do we diagnose amenorrhea?

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 or an 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. We typically use lab tests 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 you or your child 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 you or your child. Potential treatment approaches include:

• We treat those with amenorrhea, who also have PCOS, with medications to regulate their period and to help with any other concerns, such as acne. Our care team can also work with family members to help make healthy choices about food and exercise, which can greatly affect the outcome of amenorrhea treatment.
• When weight gain or loss is the cause of amenorrhea, we work to find the right nutritional support for you or your child to help regulate menstrual cycles. In addition, we may recommend medications for irregular periods, or closely monitor 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 and surgeons who treat both common and rare gynecological 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 can occur at a challenging time in a person’s life and can be very stressful. Our board-certified gynecologists have the specialized training and experience in reproductive health issues to put you or your child at ease. We carefully explain amenorrhea, discuss the various options for treatment and support you or your child with follow-up visits and consultation with our colleagues in other specialties as needed.

We work with a multidisciplinary team to ensure you or your child is receiving the best care depending on individual symptoms. Absent menstruation in adolescents or teens is unique to this particular age, so you want a care team that specializes in working with adolescents and teens.