By Virginia Liu, pediatric resident at CHOC Children’s
The start of menstruation, or menarche, marks the onset of fertility and is often an important milestone in a young girl’s development. The average age of menarche in the U.S. is 12.4 years, although there is a lot of variability, and it can depend on a number of factors such as ethnicity, genetics and nutrition. It is also very common to have irregular menstrual cycles during the first year after starting periods or menses, as the hormone regulation system is still maturing. But how can you know if the unpredictability of your daughter’s periods are a cause for concern?
Primary vs. secondary amenorrhea
Primary amenorrhea is defined as not having menses by age 15, or more than three years after secondary sexual development (such as breast development). Causes for this may include abnormalities of the genital tract or irregularities with hormone regulation. Though rare, tumors of the pituitary gland may also be a factor. These are usually associated with symptoms such as headache, vision loss, or inappropriate breast milk production.
Secondary amenorrhea is defined as three months without a period after menses has previously occurred. Causes may include pregnancy, underlying eating disorder, stress, or hormone irregularities.
What to expect during your doctor’s visit
If there is a concern for amenorrhea, consult your daughter’s primary care doctor. If she does not have a primary care doctor, find one near you. Your physician may ask questions about her medical history, family members with delayed puberty or endocrine disorders, medications including birth control use, growth and development, diet and exercise habits, and stressors. Your child’s weight will be monitored carefully during each visit. Endocrine (hormone regulation) problems are a more common cause of amenorrhea in overweight children, while eating disorders or gastrointestinal diseases are the more common cause in underweight children. Depending on your history, physical exam and symptoms, your doctor may perform additional laboratory tests including a pregnancy test or refer you to a pediatric subspecialist in genetics or endocrinology.
What can you do as a parent?
Stressors may contribute to amenorrhea. Pay attention to whether your child may have social or academic pressures, disordered eating habits, dissatisfaction with body image, or mood changes. Additional clues to keep an eye out for include acne, excessive hair growth, changes in bowel movements, abdominal pain, headaches, vision changes, and abnormal breast or vaginal discharge.