AMENORRHEA, PRIMARY |
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DESCRIPTIONPrimary amenorrhea means the absence of menstruation in a young woman who has passed puberty, is at least 16 years old, and has never menstruated. The endocrine and reproductive systems are involved.
Appropriate health care includes:
Self-care after diagnosis.
Doctor's treatment.
Psychotherapy or counseling, if your daughter's amenorrhea is stress-related or results from eating disorders.
Surgery (minor) to create an opening in the hymen, if necessary.
Surgery to correct abnormalities of your daughter's reproductive system (sometimes).
SIGNS & SYMPTOMS
Lack of menstrual periods after puberty. Most girls begin menstruating by age 14.
CAUSES
Usually unknown. Possible causes include:
Congenital abnormalities, such as the absence or abnormal formation of female organs (vagina, uterus, ovaries).
Intact hymen (membrane covering the vaginal opening) that has no opening to allow passage of menstrual flow.
Disorders (tumors, infections, or lack of maturation) of the endocrine system.
Chromosome disorders.
Emotional distress.
Eating disorders, including obesity, bulimia, anorexia nervosa, excessive dieting, or starvation.
Use of certain drugs, including mind-altering drugs, sedatives, and hormones.
Participation in highly competitive, strenuous athletic activities.
Pregnancy following intercourse prior to the first menstrual period.
RISK FACTORS
Stress; use of drugs, including oral contraceptives, anticancer drugs, barbiturates, narcotics, cortisone drugs, chlordiazepoxide, and reserpine.
PREVENTING COMPLICATIONS OR RECURRENCEInstructions for your daughter:
Don't use drugs unless prescribed for you by your doctor.
Reduce athletic activities if they are too strenuous.
Obtain medical treatment for any underlying disorder.
BASIC INFORMATION
MEDICAL TESTS
Your own observation of symptoms.
Medical history and physical exam by a doctor, including a pelvic exam.
Laboratory studies, such as a buccal smear (cells scraped from inside the cheek for chromosome studies) and blood tests of hormone levels.
POSSIBLE COMPLICATIONSPsychological distress about sexual development.
PROBABLE OUTCOME
The absence of menstruation is not a health risk. It is usually curable with hormone treatment or removal of the underlying cause. Most doctors are reluctant to begin treatment before your daughter reaches age 18 unless the cause can be identified and treated safely. Causes which sometimes cannot be corrected include chromosome disorders and abnormalities of the reproductive system.
TREATMENT
HOME CAREInstructions for your daughter:
If you have emotional stress or conflicts in your life, ask family, friends or competent counselors to help you resolve them.
Don't use mood-altering, mind-altering, stimulant, or sedative drugs.
MEDICATION
Your doctor may prescribe progesterone (hormone) treatment to induce bleeding. If bleeding begins when progesterone is withdrawn, your daughter's reproductive system is functioning. This also indicates that pituitary disease is unlikely. If progesterone withdrawal does not induce bleeding, gonad stimulants such as clomiphene or gonadotrophins may be used for the same purpose.
See Medications section for information regarding medicines your doctor may prescribe.
ACTIVITY
No restrictions. Your daughter should exercise regularly, but not to excess. She should sleep at least 8 hours every night.
DIET & FLUIDS
Your daughter should eat 3 well-balanced meals a day. If your daughter believes she is overweight, tell your doctor. Urge her not to lose weight by crash-dieting. She should avoid alcohol and should not take vitamin and mineral supplements unless your doctor prescribes them.
OK TO GO TO SCHOOL?When appetite returns and alertness, strength, and feeling of well-being will allow.
CALL YOUR DOCTOR IF
Your daughter is 16 years old and has never had a period.
Your daughter's periods don't begin in 6 months, despite treatment.
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