How is amenorrhea diagnosed?
The first step in treating amenorrhea is to determine what’s causing it, so a complete and accurate diagnosis is extremely important. If your daughter hasn’t had her first menstrual cycle by 15, or if more than three years have passed since she started developing breasts, she should see a physician.
The health care provider will start by taking her medical history and asking questions about other health issues, weight loss, weight gain, concerns about eating disorders, medications she’s taking, excess hair growth and acne, sexual activity, and family history of problems with menstrual cycles. These questions might include:
- When did you start to go through puberty and develop breasts?
- Have you ever had any vagin*l bleeding?
- When was your last menstrual period?
- Has your weight changed?
- Are you under stress or depressed?
- Has anyone thought you might have an eating disorder?
- How hard do you work to keep your weight where you want it to be?
- How much do you exercise?
- Do you have excessive hair growth or gain weight easily?
- Have you ever had sexual intercourse? Do you use contraception?
- Do you take any medications? Which ones?
The health care provider may also ask about any other physical symptoms she’s experiencing, such as headaches. Every teen is different and may require a general physical exam or external genital check. In some cases, girls might have a pelvic exam or an ultrasound. Her health care provider may also perform blood tests to check her hormone levels and a pregnancy test, so that they can consider all the possible causes of amenorrhea.
How do we treat amenorrhea?
Treatment for amenorrhea will depend on what's causing it, but most conditions that cause amenorrhea can be treated with medication and lifestyle changes. What's important is that you and your daughter understand the options and decide what type of treatment is best for her.
Depending on your daughter’s age and test results for primary amenorrhea, the health care provider may suggest watchful waiting to see if her menstrual cycle is possibly delayed. Some common medical treatments for secondary amenorrhea may help restart the menstrual cycle or treat symptoms caused by an underlying condition. They include:
- hormonal medication like birth control
- hormone replacement therapy
- medications to treat the symptoms of polycystic ovary syndrome (PCOS)
In some cases of primary or secondary amenorrhea, your daughter’s health care provider may recommend surgery. Though not common, surgery may be recommended for congenital anomalies, endocrine issues, or other conditions.
How we care for amenorrhea
The Division of Gynecology and the Reproductive Endocrinology and Polycystic Ovary Syndrome (PCOS) Program at Boston Children’s Hospital recognize the special needs of adolescents, and we create a place where they can receive expert care for amenorrhea.
