Starting around the age of 12 girls usually start to get monthly reminders from mother nature that another month has gone by without their eggs being fertilized. Some people refer to this occurrence by different terms; that time of the month, flying the red flag, seeing your menses, Aunt Flo, and so on. However, in some girls, for one reason or the other, this doesn’t happen.
Amenorrhea is the medical term for the absence of menstrual periods. Amenorrhea can be classified as primary or secondary.
Primary amenorrhea is the absence of menstrual bleeding and secondary sexual characteristics (for example, breast development and pubic hair) in a girl by age 14 years.
OR
The absence of menstrual bleeding with normal development of secondary sexual characteristics in a girl by age 16 years.
Whereas secondary amenorrhea is defined as the absence of menstrual periods for three consecutive cycles or a time period of more than six months in a woman who was previously menstruating.
Amenorrhea may be as a result of an abnormality in the hypothalamic-pituitary-ovarian axis, anatomical abnormalities of the genital tract, or functional causes.
The menstrual cycle is controlled by hormones and most of them are synthesized and controlled by the hypothalamic-pituitary-ovarian axis and any condition that interrupt this system may affect menstruation.
Being born with incompletely formed genital or pelvic organs can lead to primary amenorrhea. Some of these defects include:
- Imperforate hymen. This is a hymen that has no opening. It is a structural abnormality of the vagina. An obstruction of the vagina may prevent visible menstrual bleeding. So in this case, technically it can be said that menstruation is taking place, but there may be a membrane or wall present in the vagina that blocks the outflow of blood from the uterus and cervix. The typical presentation of the condition is amennorhea and cyclic pelvic pain, indicative of blood pooling in the cervix/vagina secondary to vaginal obstruction. An imperforate hymen is usually visible on vaginal inspection as a bulging blue membrane is present, a mass is often palpable on abdominal or rectal examination. It is usually treated by surgical incision of the hymen.
- Lack of reproductive organs. Missing uterus or vagina. Sometimes problems arise during fetal development that lead to a baby girl being born without some major part of the reproductive system, such as the uterus, cervix or vagina. In (the rare) cases where this happens, such females can’t have menstrual cycles.
One of the most common cases of primary amenorrhea in young women is Gonadal dysgenesis. This is a condition in which the ovaries are prematurely depleted of follicles and oocytes (egg cells), leads to premature failure of the ovaries.
Another genetic cause is Turner syndrome, in which women are lacking all or part of one of the two X chromosomes normally present in the female. In Turner syndrome, the ovaries are replaced by scar tissue and estrogen production is minimal, resulting in amenorrhea. Estrogen-induced maturation of the external female genitalia and sex characteristics also fails to occur in Turner syndrome.
If by age 14 your girl child has not started to have her monthly periods, it may be a good time to arrange a visit to the doctor. A proper physical examination should be done.Blood tests that may also be done include: Estradiol, FSH, LH, Prolactin, TSH, T3 and T4. Other tests that may be done include: 17 hydroxyprogesterone, Chromosome analysis, Head CT scan, Head MRI scan, Pelvic ultrasound, Serum progresterone, Serum testosterone levels.
The results of the tests may point to a possible cause and if all the results come back normal then it may just be a case of delayed development and the normal menstruation will commence eventually.
