Amenorrhea – Diagnosis and Treatment

Diagnosis

Laboratory Assessments

Different blood tests help doctors find the exact cause of amenorrhea. Pregnancy tests are often done first to confirm or rule out pregnancy as the reason for missed periods.

Doctors check thyroid hormone (TSH) levels to diagnose thyroid problems that can lead to disrupted menstrual cycles.

Measuring follicle-stimulating hormone (FSH) levels reveals if the ovaries are working as they should, important for detecting conditions like primary ovarian insufficiency or premature menopause.

Doctors check prolactin levels to screen for possible pituitary adenomas or other pituitary gland issues.

They may also investigate male hormone (androgen) levels, especially if the patient has symptoms like excess facial hair or a deepening voice, which can be linked to causes such as polycystic ovary syndrome (PCOS) or tumors.

Common Laboratory Tests Table:

Test Type	Reason for Use	Possible Conditions Found
Pregnancy test	Screen for pregnancy	Pregnancy, lactational amenorrhea
Thyroid function	Detect thyroid imbalance	Hypothyroidism, hyperthyroidism
FSH measurement	Check ovarian health	Premature ovarian failure, menopause
Prolactin level	Identify pituitary problems	Pituitary adenoma, hyperprolactinemia
Androgen hormones	Assess male hormone levels	Hyperandrogenism, PCOS

Medication-Induced Bleed Test

Doctors use the hormone challenge pill test to check for some types of ovulatory dysfunction. A patient takes a hormone pill for about a week.

If bleeding happens soon afterward, this result suggests the body isn’t making enough estrogen or that ovulation is not occurring as it should, helping to narrow down between causes like hypothalamic amenorrhea or ovarian disorders.

Imaging Procedures

Imaging studies show both anatomic abnormalities and some pituitary or hypothalamic disorders. Pelvic ultrasound helps doctors see the uterus and ovaries. This test can find conditions like Müllerian agenesis, imperforate hymen, or ovarian cysts.

MRI scans help doctors investigate suspected pituitary tumors, pituitary dysfunction, or other brain-related issues affecting menstruation. These scans provide clear images of soft tissue and the pituitary region.

Direct Uterine Viewing Exams

If other tests do not show a clear cause, a doctor might suggest a procedure called a uterine camera exam (hysteroscopy).

This test lets doctors look inside the uterus to check for intrauterine adhesions (Asherman syndrome), cervical stenosis, or other structural problems that can cause secondary amenorrhea, delayed menarche, or changes in menstrual patterns.

This test also helps doctors distinguish cases where menstruation is blocked due to physical barriers like a transverse vaginal septum or scarring after surgery, such as a hysterectomy.

Treatment

Treatment options depend on what is causing the missed periods. Common approaches include:

• Doctors may prescribe hormone therapy, such as birth control pills, estrogen, or progesterone, to help restart the menstrual cycle.
• They use medicines to treat thyroid or pituitary problems.
• Surgeons may operate to remove tumors or blockages.

For conditions like polycystic ovary syndrome (PCOS), doctors may use medicines to balance hormones like testosterone, luteinizing hormone (LH), or follicle-stimulating hormone (FSH).

In some cases, they may use hormone replacement therapy or gonadotropin-releasing hormone (GnRH) treatment, especially if ovarian failure or infertility is present.

Healthy Habits and Home Approaches

Balancing exercise, nutrition, and rest supports normal menstrual cycles.

Overtraining or not eating enough can lead to missed periods, while maintaining a steady weight and eating a nutritious diet is important for those with eating disorders such as anorexia or bulimia.

Monitoring intake of calcium and vitamin D protects bone density, reducing the risk of osteoporosis over time.

Tracking period dates, symptoms, and duration makes it easier to spot changes, especially for people with chronic diseases or who are overweight. If periods remain irregular, consult a healthcare professional.

Getting Ready for Your Visit

Steps to Prepare Before Your Appointment

• Document Your Symptoms: Write down when your symptoms started and how long they have lasted. Note the date of your last period if you remember it.

• Collect Medical Details: Make a list of any health conditions you have. Include all medications, vitamins, or supplements you use with their names and dosages.

• Review Your Family’s Health History: Find out if your mother, sisters, or other close relatives have had any menstrual concerns or similar health issues.

• Prepare Questions to Ask:
  List your questions, starting with the most important. Some examples include:
  • What could be causing the missed periods?
  • Are tests needed, and how should you prepare for them?
  • What treatments are available, and which are recommended?

Helpful Tips
Bring your notes and questions to your appointment.
Share honest and clear information with your doctor.
Bring a list of your medications and supplements.

What Questions Your Doctor May Ask

During your visit, the doctor may:

• Ask About Your Medical History: Your doctor will likely want details about your last period, other health conditions, medication use, and any family history of period problems.

• Discuss Your Daily Life: Your doctor may ask about your diet, exercise routines, stress levels, and whether you could be pregnant or use birth control.

• Conduct a Physical Exam: Your doctor may check your weight, overall health, and look for signs related to hormone balance or other possible causes of missed periods.

• Assess Other Factors: Your doctor might ask about recent weight changes, sexual activity, and lifestyle habits to get a full picture of your health.