Amenorrhea (absence of menstrual flow) is a symptom of a vari-ety of disorders and dysfunctions. Primary amenorrhea (delayed menarche) refers to the situation in which a young woman older than 16 has not begun to menstruate but otherwise shows evi-dence of sexual maturation, or when a young woman has not begun to menstruate and has not begun to show development of secondary sex characteristics by 14 years of age. Amenorrhea may be of considerable concern but is usually due to minor variations in body build, heredity, environment, and physical, mental, and emotional development.
The nurse allows the patient to express her concerns and anx-iety about this problem, because the patient may feel that she is different from her peers. A complete physical examination, care-ful health history, and simple laboratory tests help to rule out pos-sible causes, such as physiologic disorders, metabolic or endocrine difficulties, and systemic diseases. Treatment is directed toward correcting any abnormalities.
Secondary amenorrhea (an absence of menses for three cycles or 6 months after a normal menarche) may be caused by preg-nancy, tension, emotional upset, or stress. In an adolescent, sec-ondary amenorrhea is usually caused by minor emotional upset related to being away from home, attending college, tension due to schoolwork, or interpersonal problems. The second most com-mon cause, however, is pregnancy, so a pregnancy test is almost always indicated.
Secondary nutritional disturbances may also be factors. Obe-sity can result in anovulation and subsequent amenorrhea. Eat-ing disorders, such as anorexia and bulimia, are characterized by lack of menses because the decrease in body fat and caloric intake affects hormonal function. Competitive female athletes typically experience amenorrhea and are frequently placed on HRT to prevent bone loss related to low estrogen levels. On occasion, a pituitary or thyroid dysfunction may cause amenorrhea. These dysfunctions can be treated successfully by treatment of the un-derlying endocrine disorder. Infrequent periods (oligomenor-rhea) may be related to thyroid disorders, polycystic ovarian syndrome, or premature ovarian failure. Again, evaluation by a primary health care provider is necessary.