Amenorrhea

Diagnosis

During your appointment, your healthcare professional may perform a pelvic exam to check your reproductive organs. If you've never had a period, your healthcare professional may look at your breasts and genitals to check for the typical changes of puberty.

Amenorrhea can be a sign of a complex set of hormonal conditions. Finding the underlying cause can take time. You may need more than one kind of testing.

Blood tests

You may need a variety of blood tests, including:

• Pregnancy test. This will probably be the first test you have done. It can rule out or confirm a possible pregnancy.
• Thyroid function test. Measuring the amount of thyroid-stimulating hormone in your blood can show whether your thyroid is working as it should.
• Ovary function test. Looking at the level of follicle-stimulating hormone in your blood helps show how well your ovaries are working.
• Prolactin test. High levels of the hormone prolactin may be a sign of a pituitary gland tumor.
• Androgen hormone test. If you have increased facial hair and a lowered voice, you may be checked for the level of androgen hormones in your blood, such as testosterone or androstenedione.

Progestin challenge test

For this test, you take a hormonal medicine for 5 to 10 days to trigger menstrual bleeding. Results from this test can tell your healthcare professional whether your periods have stopped due to a lack of estrogen.

Imaging tests

After getting blood test results, your doctor or other healthcare professional may recommend one or more imaging tests depending on your medical history. Possible imaging tests include:

• Ultrasound. This test uses sound waves to produce images of internal organs. If you have never had a period, your healthcare professional may suggest an ultrasound test to check for anything that is not typical about your reproductive organs.
• Magnetic resonance imaging (MRI). MRI uses radio waves with a strong magnetic field to produce very detailed images of soft tissues within the body. Your healthcare professional may order an MRI to check for a pituitary tumor or get more information about the results of an ultrasound.

Scope tests

If other testing reveals no specific cause and there is concern about uterine scarring, your healthcare professional may recommend a hysteroscopy. This is a test in which a thin, lighted tube with a camera on the end is passed through the vagina and cervix to look at the inside of the uterus.

Treatment

Treatment for amenorrhea depends on the underlying cause. Sometimes, birth control pills or other hormone therapies can restart your menstrual bleeding or cycles. Amenorrhea caused by thyroid or pituitary conditions may be treated with medicines. If a tumor or blockage is causing the condition, you may need surgery.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

Lifestyle factors such as too much exercise or too little food can cause amenorrhea, so strive for balance in work, recreation and rest. Assess areas of stress and conflict in your life and think about ways you might be able to relieve some of that stress. If you can't lower stress on your own, ask for help from family, friends or your healthcare professional.

Watch for changes in your menstrual cycle and check with your doctor or other healthcare professional if you have concerns. Keep a record of when you get your periods. Note the date your period starts and the date that it ends. Also keep track of any troublesome symptoms you may have during your period and the days leading up to it.

Preparing for your appointment

Your first appointment will likely be with your primary healthcare professional or gynecologist.

Here's some information to help you prepare for your appointment and know what to expect from your healthcare professional.

What you can do

To get ready for your appointment:

• Write down details about your symptoms, including when they started. Also write down the date your last period started, if you know it, and how long that period lasted.
• Make a note of key medical information, including other conditions for which you're being treated and the names and dosages of any medicines, vitamins and supplements you regularly take.
• Review your family history, checking to see whether your mother or any sisters also have had conditions related to their periods.
• Write down questions to ask your healthcare professional, listing the most important ones first.

For amenorrhea, some basic questions to ask your healthcare professional include:

• What might be causing me to miss my periods?
• Do I need any tests? How should I prepare for those tests?
• What treatments are available? Which do you recommend for me?
• Where can I go to get more information? Do you have any brochures on this topic? What websites do you recommend?

What to expect from your doctor

Your healthcare professional is likely to ask you a number of questions such as:

• When was your last period?
• Are you sexually active?
• Could you be pregnant?
• Do you use birth control?
• How would you rate your stress level on a typical day?
• Have you recently lost or gained weight without trying to? Or have you lost a lot of weight very quickly?
• How often and how intensely do you exercise?
• Do you have any other medical conditions?