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It has been gathered that 75% girls begin breast development by age 11.5 years. By age 12 more than 95% girls begin breast development. So it is perfectly fine to evaluate no menstruation state after age of 13 years. Eating disorders is considered one of the causes of primary amenorrhea. Appropriate evaluation and referral becomes necessary in such cases.
Around 0.3% to 0.5% of young women are found to have the condition of Anorexia Nervosa and majority of the cases are in age group of 15 to 19 years. While diagnosing anorexia nervosa, amenorrhea is found as one of necessary features. Other contributing factors are excessive exercise, low body weight, and stress -induced activation of the hypothalamic function. Low body weight and amenorrhea has some kind of relationship; however, it is not always the case. It has been found that around 20% of the women with anorexia nervosa have been found to develop amenorrhea before they lose significant body weight. It is important to notice that young women with bulimia nervosa are of normal weight even then they are found to suffer from irregular menses, perhaps due to dietary restriction. At times, many women do have some kind of eating disorders that cannot be classified as anorexia nervosa or bulimia nervosa adolescents but they are part of an eating disorder not otherwise specified (EDNOS) and some of them are also found to have amenorrhea. Usually, weight restoration and nutritional food resumes menses.
Amenorrhea may also occur due to prolong use of antipsychotic medication. Antipsychotic drugs have been found to block dopamine D2 receptors increasing prolactin secretion by 5-10 times from the pituitary gland. Antidepressants too have been found to increase prolactin levels. Contraceptives in injectable form also cause amenorrhea. The use of medroxyprogesterone acetate (DMPA) causes amenorrhea in 50% of cases and that number increases to 75%, if its use continues for two years. Stress, physical or
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