Menstruation: Absent Periods (Amenorrhea)

Description

Alternative Names

Menstrual Disorders

Amenorrhea is the absence of menstruation. There are two categories: primary amenorrhea and secondary amenorrhea. Such terms are used only to describe the timing of menstrual cessation; they do not indicate any cause or suggest any other information.

• Primary amenorrhea occurs when a girl does not even start to menstruate. Girls who show no signs of sexual development (breast development and pubic hair) by age 14 should be evaluated. Girls who do not have their periods by two years after sexual development should also be checked. Any girl who does not have her period by age 16 should be evaluated for primary amenorrhea.
• Secondary amenorrhea is a condition in which periods that were previously regular become absent for at least three cycles.

Other Menstrual Disorders

Oligomenorrhea (Light or Infrequent Menstruation). Oligomenorrhea is a condition in which menstrual cycles are infrequent. It is very common in early puberty and not usually worrisome. When girls first menstruate they often do not have regular cycles for several of years. Even healthy cycles in adult women can vary by a few days from month to month. In some women, periods may occur every three weeks and in others, every five weeks. Flow also varies and can be heavy or light. Skipping a period and then having a heavy flow may occur; this is most likely due to missed ovulation rather than a miscarriage. Women should be concerned when periods come less than 21 days or more than three months apart, or if they last more than ten days. Such events may indicate ovulation problems.

Menorrhagia (Heavy Bleeding). During normal menstruation the average woman loses about 2 ounces (60 ml) of blood or less. If bleeding is significantly heavier, it is called menorrhagia, which occurs in 9% to 14% of all women and can be caused by a number of factors. Women often over estimate the amount of blood lost during their periods. However, women should consult their physician if any of the following occurs:

• Soaking through at least one pad or tampon every hour for several hours.
• Heavy periods that regularly last 10 or more days.
• Bleeding between periods or during pregnancy. Spotting or light bleeding between periods is common in girls just starting menstruation and sometimes during ovulation in young adult women, but consultation with a physician is nevertheless recommended.

Note: Clot formation is fairly common during heavy bleeding and is not a cause for concern. [See Well-Connected Report # 80, Menorrhagia.]

Dysmenorrhea (Severe Menstrual Cramps). Dysmenorrhea is severe, frequent cramping during menstruation. Cramps occur from contractions in the uterus, which are part of the menstrual process. The condition is usually referred to as primary or secondary.

• Primary dysmenorrhea. With primary dysmenorrhea, muscle contractions are often normal and the cause of the pain is some underlying biologic factor that only affects menstrual cramping. About half of menstruating women experience primary dysmenorrhea. Onset is usually two to three years after the periods have started. The pain typically develops when the bleeding starts and continues for 32 to 48 hours.
• Secondary dysmenorrhea. Secondary dysmenorrhea is pain related to menstruation that accompanies another medical or physical condition, usually endometriosis or pelvic abnormalities. [For more information, see Well-Connected Report #100, Dysmenorrhea.]

Premenstrual Syndrome. In general premenstrual syndrome (PMS) is a set of physical, emotional, and behavioral symptoms that occur during the last week of the luteal phase (a week before menstruation) in most cycles. The symptoms should typically resolve within four days after bleeding starts and not start until at least day 13 in the cycle. Women may begin to experience premenstrual syndrome symptoms at any time during their reproductive years. Once established, the symptoms tend to remain fairly constant until menopause, although they can vary from cycle to cycle. About 100 symptoms have been identified with the premenstrual phase.

Up to 80% of all women report some symptoms related to fluctuating hormone levels as menstruation approaches. For about half of these women, symptoms are mild and do not affect normal daily life. The other half report symptoms severe enough to impair daily life and relationships. [For more details, see Well-Connected Report #79, Premenstrual Syndrome.]