The absence of a period in girls can stem from a variety of reasons, including hormonal imbalances, lifestyle factors, medical conditions, and anatomical issues.
Here's a breakdown of potential causes:
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Age and Puberty: It's important to first establish if the girl has reached the typical age for menstruation. Menarche (the first period) usually occurs between ages 10 and 16. If a girl is older than 16 and hasn't started menstruating, it warrants investigation.
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Primary Amenorrhea: This refers to the absence of menstruation by age 16. Possible causes include:
- Genetic Conditions: Chromosomal abnormalities like Turner syndrome can affect ovarian development.
- Anatomical Issues: Problems with the reproductive organs, such as an absent uterus or vagina, can prevent menstruation.
- Hormonal Problems: Issues with the pituitary gland or hypothalamus, which control hormone production, can disrupt the menstrual cycle.
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Secondary Amenorrhea: This is when a girl who has previously had regular periods stops menstruating for three months or more. Common causes include:
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Pregnancy: This is the most common cause of secondary amenorrhea in sexually active women.
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Hormonal Contraceptives: Birth control pills, implants, or injections can sometimes stop periods.
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Lifestyle Factors:
- Excessive Exercise: Intense physical activity, especially when coupled with low body weight, can disrupt hormonal balance.
- Eating Disorders: Anorexia nervosa and bulimia can cause hormonal imbalances that lead to amenorrhea.
- Stress: High levels of stress can affect the hypothalamus and disrupt the menstrual cycle.
- Weight Fluctuations: Being significantly underweight or overweight can both affect menstruation.
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Medical Conditions:
- Polycystic Ovary Syndrome (PCOS): This hormonal disorder can cause irregular periods or amenorrhea.
- Thyroid Problems: Both hypothyroidism (underactive thyroid) and hyperthyroidism (overactive thyroid) can affect menstruation.
- Pituitary Tumors: Noncancerous tumors on the pituitary gland can disrupt hormone production.
- Premature Ovarian Failure: The ovaries stop functioning before age 40.
- Certain Medications: Some medications, such as antidepressants, antipsychotics, and chemotherapy drugs, can cause amenorrhea.
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Breastfeeding: Breastfeeding often suppresses ovulation and menstruation.
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Hormonal Imbalances (General): Beyond specific conditions, general hormonal imbalances can also delay or stop periods. This can sometimes occur during the years immediately after menarche as the body adjusts.
When to See a Doctor:
A girl or her parents should consult a doctor if:
- She hasn't started menstruating by age 16.
- She has previously had regular periods but has missed three or more periods in a row.
- She experiences other symptoms along with amenorrhea, such as hair loss, acne, pelvic pain, or vision changes.
A doctor can perform a physical exam, review medical history, and order blood tests or imaging scans to determine the underlying cause of amenorrhea and recommend appropriate treatment.
