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

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Amenorrhea in teens can be due to various reasons, ranging from lifestyle factors to hormonal issues and congenital anatomical disabilitiesⁱConditions present from birth and could be hereditary or due to infection or injury to the fetus . Amenorrhea refers to missed periods for more than three months or a complete absence of menstruation. The first menstruation (menarche) usually occurs around 12-13 years of age, and nearly 98% of girls experience puberty and menarche by the age of 15 (1). It is recommended to seek medical care if your girl’s menstruation has not begun by this age or has missed periods for more than three months. Doctors may recommend pharmacological or non-pharmacological interventions for amenorrhea based on diagnostic tests and pelvic ultrasound findings.

Read on to learn the causes, signs, complications, and treatments for missed periods in teens.

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 ovulationⁱPeriod when the ovary produces an egg every month. However, if this persists, your teen may require a gynecology consultation to evaluate her reproductive health and determine the underlying cause.

Causes Of Missed Periods In Teenagers

Causes of amenorrhea in teenage girls include (3): 

1. Polycystic ovary syndrome (PCOS): PCOS is believed to impact approximately 6% to 12% of women of reproductive age in the United States. This condition may have an effect on up to 5 million individuals, as stated by the data provided by the US Centers for Disease Control and Prevention (CDC). PCOS may cause hormonal imbalances and ovulation failure, thus leading to amenorrhea.

Adriana Espinosa Janković, a blogger, was diagnosed with PCOS at a young age. She was prescribed birth control pills at the age of 15 to control her symptoms. However, upon moving to Mexico, her anorexia relapsed, and she stopped taking birth control pills as per her nutritionist’s advice. She says, “Doing this stopped my periods from coming completely, also known as amenorrhea. So I went from having a monthly period to only having about one or two periods per year (i).”

2. Under or overactive thyroid gland: Thyroid hormones can interfere with ovulation.

3. Obesity and underweight: These factors may affect the hormones that regulate the menstrual cycle and trigger amenorrhea. 

4. Heavy workouts (athletes) and dieting: Low body fat, stress, and high energy use could interrupt normal periods. 

5. Eating disorders such as anorexia: These could cause extreme weight loss and affect hormone levels, thus causing amenorrhea.

6. Pituitary tumors: Pituitary tumors, such as prolactinomas, can disrupt normal hormone levels and cause amenorrhea.

7. Structural abnormalities of the reproductive system: Absence of reproductive organs; and various other defects which your doctor will be able to diagnose

8. Pregnancy: During pregnancy, hormone levels change, and the endometriumⁱThe inner lining of the uterus is not shed; therefore, there is a natural absence of menstruation.

9. Stress: This may affect the function of the hypothalamus in regulating the menstrual cycle.

10. 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 contraception use.

11. Medications and drug interactions: Certain drugs could interfere with menstrual hormones or hypothalamic regulation of hormonal function and suppress ovulation, thus resulting in amenorrhea.

12. Lifestyle changes: Increased physical activity or drastic dietary changes can also cause irregular periods. Amenorrhea can occur in teenage athletes who go through strict diet control and excessive exercise (4).

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 (5):

• Weight loss or gain: Unusual changes in body weight, whether it’s gaining or losing, may occur in teenage athletes and those with eating disorders and thyroid problems.

• Acne, facial hair, hair loss in teenage girls: 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 (6):

• Obesity
• Eating disorders

• Thyroid disorders such as hypothyroidismⁱWhen the thyroid gland does not produce and release enough thyroid hormone into the bloodstream or hyperthyroidismⁱWhen the thyroid gland produces more thyroid hormones than the body requires
• Structural defects

Complications Of Amenorrhea In Teens

The possible complications of amenorrhea include (7):

• 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 estrogenⁱA sex hormone linked to the female reproductive system 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 you notice irregular periods in teens 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 evaluation of both the mother and baby. An early prenatal visit could help reduce the risk of complications associated with teenage 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 (8):

• 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 (8):

• 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. Sometimes, the doctor may also ask for family history as it may help them recognize potential hereditary conditions that may affect your teen’s menstrual health.

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 (9):

• ProgesteroneⁱA hormone produced by the female reproductive system, crucial for maintaining a regular menstrual cycle and pregnancy 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 (13).

You may encourage your teen to exercise and follow healthy eating habits from an early age to support hormonal balance. Do not hesitate to consult a doctor if you notice unusual weight changes, eating disorders, or stress in your teen. You may also encourage your teen to track their menstrual cycle with an app or journal to track any change in period patterns or irregularities.

Illustration: Causes Of Missed Periods In Teens (Apart From Pregnancy)

Irregular periods are common in teens and may occur due to several reasons. Discover in this informative video about the causes and treatments for irregular periods in teens.

 

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