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Irregular Menstruation in Teens
Q: My 14-year-old daughter got her first menstrual period just after she turned 13. After 6 months of regular periods, they stopped, and she has not had a period for 5 months. There is no chance she is pregnant. Is this normal?
A: While it is common for girls to have irregular periods during the first year they start menstruating, it's not normal to go five months without a period, after having them regularly for many months. The medical term for not having periods is amenorrhea, and when this condition goes beyond about three months, then further evaluation is usually needed.
One of the common reasons for girls to stop having their periods for many months is that they have lost weight. Amenorrhea often occurs when the level of body fat in a girl goes below about 12 to 15 percent. Girls who are athletes -- particularly runners, gymnasts, and dancers -- are more prone to this as they intensify their training. It's also a common consequence in girls who have eating disorders.
There is also the possibility that there's no underlying abnormality, and that within another month your daughter will start to have menstrual cycles again. Various hormonal problems, however, can cause the menstrual cycles to stop in teenagers. Most of these problems are quite treatable, and it makes sense to try to diagnose them early.
Make an appointment for your daughter to see her physician as soon as possible to sort out the reason for her amenorrhea. The hormones that are present during the menstrual cycle are important in helping to increase and maintain bone density in teenage girls. Girls who have prolonged periods of amenorrhea do lose some bone density, and thus have an increased susceptibility to fractures now, as well as a greater susceptibility to osteoporosis and fractures later on in life.
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Shari Nethersole is a physician at Children's Hospital, Boston, and an instructor in Pediatrics at Harvard Medical School. She graduated from Yale University and Harvard Medical School, and did her internship and residency at Children's Hospital, Boston. As a pediatrician, she tries to work with parents to identify and address their concerns.