Q& A

Irish Independent - Health & Living - - ADVICE -

THE av­er­age age at first menstruation is 12.4 years with­a­range­ofa­genineto 16. There are a num­ber of fac­tors that in­flu­ence this, but one of the strong­est ones is weight. The crit­i­cal body weight is 46 to 47kg. Body fat should — at a min­i­mum — be 17pc for menstruation to start and 22pc to main­tain it.

It takes on av­er­age one to three years for the com­plex hor­mone cy­cle to ma­ture once menstruation com­mences. The av­er­age men­strual pe­riod lasts from three to seven days and oc­curs at a cy­cle of be­tween 21 and 35 days. The range of nor­mal varies greatly and sim­ply un­der­stand­ing this may be enough to put your mind at rest.

In or­der for menstruation to oc­cur the body must be pro­gress­ing through the var­i­ous stages of pu­berty.

Pri­mary amen­or­rhoea is de­fined as the ab­sence of menstruation by age 16. The first step in de­cid­ing the cause is to check how pu­berty is pro­gress­ing. If your daugh­ter is show­ing all other signs of pu­berty, namely a change in body shape, the growth of hair in the pu­bic area and un­der her arms and nor­mal breast de­vel­op­ment then this is re­as­sur­ing. You de­scribe a thin ac­tive girl and it sounds to me that this may in­deed be the cause of de­layed menstruation.

Psy­cho­log­i­cal dis­tress can also de­lay menstruation. You say your daugh­ter is happy and ac­tive, so this doesn’t seem to be the cause. Anx­i­ety and stress are, how­ever, very com­mon in teens to­day and it is im­por­tant to be vig­i­lant.

As she is nearly 16 I do feel fur­ther in­ves­ti­ga­tion is war­ranted. Some sim­ple blood tests can rule out hor­monal causes such as pi­tu­itary prob­lems or poly­cys­tic ovar­ian syn­drome. Your doc­tor can do a gen­eral ex­am­i­na­tion to en­sure no other causes are sus­pected. An ul­tra­sound can help rule out ab­nor­mal­i­ties of the womb or ovaries.

If the cause is felt to be down to

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