Diagnosis

During your appointment, your doctor will perform a pelvic exam to check for any problems with your reproductive organs. If you've never had a period, your doctor may examine your breasts and genitals to see if you're experiencing the normal changes of puberty.

Amenorrhea can be a sign of a complex set of hormonal problems. Finding the underlying cause can take time and may require more than one kind of testing.

Lab tests

A variety of blood tests may be necessary, including:

  • Pregnancy test. This will probably be the first test your doctor suggests, to rule out or confirm a possible pregnancy.
  • Thyroid function test. Measuring the amount of thyroid-stimulating hormone (TSH) in your blood can determine if your thyroid is working properly.
  • Ovary function test. Measuring the amount of follicle-stimulating hormone (FSH) in your blood can determine if your ovaries are working properly.
  • Prolactin test. Low levels of the hormone prolactin may be a sign of a pituitary gland tumor.
  • Male hormone test. If you're experiencing increased facial hair and a lowered voice, your doctor may want to check the level of male hormones in your blood.

Hormone challenge test

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

Imaging tests

Depending on your signs and symptoms — and the result of any blood tests you've had — your doctor might recommend one or more imaging tests, including:

  • Ultrasound. This test uses sound waves to produce images of internal organs. If you have never had a period, your doctor may suggest an ultrasound test to check for any abnormalities in your reproductive organs.
  • Computerized tomography (CT). CT scans combine many X-ray images taken from different directions to create cross-sectional views of internal structures. A CT scan can indicate whether your uterus, ovaries and kidneys look normal.
  • Magnetic resonance imaging (MRI). MRI uses radio waves with a strong magnetic field to produce exceptionally detailed images of soft tissues within the body. Your doctor may order an MRI to check for a pituitary tumor.

Scope tests

If other testing reveals no specific cause, your doctor may recommend a hysteroscopy — a test in which a thin, lighted camera is passed through your vagina and cervix to look at the inside of your uterus.

Treatment

Treatment depends on the underlying cause of your amenorrhea. In some cases, contraceptive pills or other hormone therapies can restart your menstrual cycles. Amenorrhea caused by thyroid or pituitary disorders may be treated with medications. If a tumor or structural blockage is causing the problem, surgery may be necessary.

Lifestyle and home remedies

Some 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. If you can't decrease stress on your own, ask for help from family, friends or your doctor.

Be aware of changes in your menstrual cycle and check with your doctor if you have concerns. Keep a record of when your periods occur. Note the date your period starts, how long it lasts and any troublesome symptoms you experience.

Preparing for your appointment

Your first appointment will likely be with your primary care physician or gynecologist.

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

What you can do

To get ready for your appointment:

  • Write down details about your symptoms, including when they started and the date and duration of your last period, if you know when your last period was.
  • Make note of key medical information, including other conditions for which you're being treated and the names and dosages of any medications, vitamins or supplements you regularly take.
  • Review your family history, checking to see whether your mother or any sisters have also had menstrual problems.
  • Write down questions to ask your doctor, listing the most important ones first in case time runs short.

For amenorrhea, some basic questions to ask your doctor 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?
  • Do you have any informational brochures on this topic? What websites do you recommend?

What to expect from your doctor

Your doctor will likely 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?
  • Are you under any stress?
  • Have you experienced unexplained weight gain or weight loss?
  • How often and how intensely do you exercise?
  • Do you have any other medical conditions?
May 09, 2014
References
  1. DeCherney AH, et al. Current Diagnosis & Treatment Obstetrics & Gynecology.11th ed. New York, N.Y.: The McGraw-Hill Companies; 2013. http://www.accessmedicine.com/resourceTOC.aspx?resourceID=788. Accessed Jan. 21, 2014.
  2. Klein DA, et al. Amenorrhea: An approach to diagnosis and management. American Family Physician. 2013;87:781.
  3. Goldman L, et al. Goldman's Cecil Medicine. 24th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. http://www.clinicalkey.com. Accessed Jan. 20, 2014.
  4. Welt CK, et al. Etiology, diagnosis and treatment of secondary amenorrhea. http://www.uptodate.com/home. Accessed Jan. 21, 2014.
  5. Welt CK, et al. Etiology, diagnosis and treatment of primary amenorrhea. http://www.uptodate.com/home. Accessed Jan. 21, 2014.
  6. Bope ET, et al. Conn's Current Therapy. Philadelphia, Pa.: Saunders Elsevier; 2013. http://www.clinicalkey.com. Accessed Jan. 20, 2014.