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What Causes Missed Period (Amenorrhea) In Teens And When To Seek Help?

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Menarche or the first menstrual cycle, begins at an average age of 12-13 years in most girls. By the age of 15, 98% of girls would have had menarche (1). If your teen girl does not have menstruation by this age or has missed periods for more than three months, you may seek medical attention.

Read this post to know about the causes, symptoms, complications, diagnosis, treatments, and prevention of missed periods in teenagers.

What Is Amenorrhea In A Teen?

The absence of menstrual periods is called amenorrhea. There are two types of amenorrhea (2):

  • Primary amenorrhea: This refers to the absence of menarche by the age of 15 years.
  • Secondary amenorrhea: This refers to the absence of menstrual periods for three months or more in otherwise healthy menstruating teens.

Missed periods are normal and common during the first and second years of menstruation. They can be caused due to a lack of ovulation every month. However, your teen may require a gynecology consultation to determine the cause, if this persists.

Causes Of Missed Periods In Teenagers

Causes of amenorrhea in teenage girls include (3): 

  1. Polycystic ovarian syndrome (PCOS): This may cause hormonal imbalances and ovulation failure, thus leading to amenorrhea.
  1. Under or overactive thyroid gland: Thyroid hormones can interfere with ovulation.
  1. Obesity and underweight: These factors may affect the hormones that regulate the menstrual cycle and trigger amenorrhea. 
  1. Heavy workouts (athletes) and dieting: Low body fat, stress, and high energy use could interrupt normal periods. 
  1. Eating disorders such as anorexia: These could cause extreme weight loss and affect hormone levels, thus causing amenorrhea.
  1. Pituitary tumors: Pituitary tumors, such as prolactinomas, can disruptnormal hormone levels and cause amenorrhea.
  1. Structural abnormalities of the reproductive system: Absence of reproductive organs; and various other defects which your doctor will be able to diagnose
  1. Pregnancy: During pregnancy,hormone levels change, and the endometrium is not shed; therefore, there is a natural absence of menstruation.
  1. Stress: This may affect the function of the hypothalamus in regulating the menstrual cycle.
  1. Birth control pills, IUDs, and shots: Hormonal contraceptives interfere with menstruation due to the suppression of ovulation. Sometimes, it may take a while to return to the normal cycle even after the cessation of contraceptive use.
  1. Medications and drug interactions: Certain drugs could interfere with menstrual hormones or hypothalamic regulation of hormonal function and suppress ovulation, thus resulting in amenorrhea.

The most common cause of missed periods after the first year of menarche is pregnancy . Chronic illnesses such as tuberculosis, inflammatory bowel disease, etc., may also cause amenorrhea.

Symptoms Of Missed Periods In Teens

Lack of menstrual bleeding is the main symptom of amenorrhea. The other signs and symptoms may depend on the cause.

These may include (4):

  • Weight loss or gain: This can be seen in teenage athletes and those with eating disorders and thyroid problems.
  • Facial hair, hair loss, acne: These symptoms can be associated with polycystic ovarian disease and other hormonal imbalances.
  • Morning sickness: Nausea and vomiting can often be seen in the case of pregnancy.

These are signs and symptoms of conditions that may contribute to amenorrhea. You may visit your teen’s healthcare provider for an accurate diagnosis. 

Risk For Amenorrhea In Teens

Teenage athletes and teens with the following conditions may have a higher risk for amenorrhea (5):

  • Obesity
  • Eating disorders
  • Thyroid disorders such as hypothyroidism or hyperthyroidism
  • Structural defects

Complications Of Amenorrhea In Teens

The possible complications of amenorrhea include (6):

  • Infertility: Pregnancy can become difficult or not possible if missed periods are due to a lack of ovulation or specific structural abnormalities.
  • Bone thinning: Missed periods may occur as a result of low levels of estrogen hormones. Low estrogen levels may contribute to osteoporosis or thinning of the bones in the long-term.

If your teen’s estrogen levels are low,  her doctor may recommend calcium supplements to prevent osteoporosis in the future. Due to recent advances in medicine, infertility can be treated with various methods. However, a thorough assessment could help your teen’s healthcare provider to take necessary measures to prevent these complications.

When To See The Doctor?

It is advised to get a medical consultation after your teen’s first period itself. If your teen has irregular periods or missed periods, make an appointment with a gynecologist to identify the cause and take preventive measures if required.

If your teen has any symptoms of thyroid disorders, eating disorders, or stress,  seek medical care. You may take a doctor’s advice regarding nutrition and exercises if your teen is an athlete.

If your teen is pregnant, you may seek medical care for the evaluationof both the mother and baby. An early prenatal visit could help reduce the risk of complications associated with teen pregnancy and delivery.

Diagnosis Of Amenorrhea In Teens

Your teen’s doctor may ask about the symptoms and menstrual history of your teen. They may also do a physical examination, including a pelvic exam, to look for any visible abnormalities or signs of conditions that cause amenorrhea.

Amenorrhea is diagnosed in the following scenarios (7):

  • Absence of menarche by the age of 15 years
  • Lack of menstruation for three months or more in a girl with regular cycles
  • Missed menstruation for six months or more in a girl with irregular cycles

The following tests may be ordered to identify the underlying cause of amenorrhea (7):

  • Blood tests: Hormone levels, pregnancy, thyroid disorder
  • Urine analysis: pregnancy and overall health
  • Pelvic ultrasound: Ultrasonographic imaging of the pelvic area can help identify the structural causes of amenorrhea.

Your teen may also require a few additional tests and consultations to confirm or exclude the diagnosis of possible underlying causes. These tests are usually suggested by your teen’s doctor.

Treatments For Missed Periods In Teens

Treatment depends on the cause of amenorrhea and its severity. The symptoms, health status, and age of your teen are also considered to decide the treatment.

Treatments for missed periods may include (8):

  • Progesterone hormone therapy
  • Hormone therapy using oral contraceptives (birth control pills)
  • Correction of thyroid hormone with hormone supplements or medication
  • Surgeries for structural anomalies
  • Changes in diet and exercise plans
  • Management of eating disorders
  • Calcium supplements

Your teen’s doctor may consider the risks, benefits, and side effects of medicines before prescribing them. Surgical treatments are given in the case of uterine scarring, repairable structural anomalies, and pituitary tumors.

These medications are given based on individual cases, and the type of medicine and dosage may vary for each teen. You should not provide any hormonal or other treatments to your teen without the supervision of a healthcare provider. It may harm their reproductive and general health. 

Prevention Of Missed Periods In Teenagers

A few causes of amenorrhea can be prevented with a specific diet or lifestyle modifications. However, these may not always be the reason for missed periods. Therefore, it is good to see a healthcare provider for guidance (2).

You may encourage your teen to exercise and follow healthy eating habits from an early age. Do not hesitate to consult a doctor if you notice unusual weight changes, eating disorders, or stress in your teen.

Although menstrual irregularities are typical in teens, missed periods may require medical attention and timely interventions to prevent adverse outcomes and future reproductive problems. You may also pay attention to abnormal uterine bleeding other than periods that require medical evaluation.

Educate your teen on reproductive health so that they can talk to you if they have any issues. Appropriate sex education could reduce the risk of unintended teen pregnancies and sexually transmissible infections in teens.  

References:

1. Menstruation in Girls and Adolescents: Using the Menstrual Cycle as a Vital Sign; The  American College of Obstetricians and Gynecologists
2. Amenorrhea; Children’s Hospital of Philadelphia
3. Amenorrhea in teens; Nicklaus Children’s Hospital
4. Amenorrhea; American Academy of Family Physicians
5. Amenorrhea in teens; University of Rochester Medical Center (URMC)
6. Amenorrhea; NCH Healthcare System
7. David A. Klein, and Merrily A. Poth; Amenorrhea: An Approach to Diagnosis and Management; American Academy of Family Physicians
8. What are the treatments for amenorrhea?; The Eunice Kennedy Shriver National Institute of Child Health and Human Development; The National Institutes of Health

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