Amenorrhea is the absence of menstruation. Many women may not know why periods are late or absent, so it is important to consult a doctor should amenorrhea occur. Amenorrhea causes are varied, but are closely linked because several glands and hormones work together to regulate the menstrual cycle and other body processes. Many lab and imaging tests may be required to diagnose the cause of amenorrhea. Determining the cause is important to finding the right treatment.
Diagnosis - Blood Testing and Physical Examinations
The diagnosis of amenorrhea includes several tests that evaluate the physical and chemical properties of the body. Pregnancy testing is the first step to rule out amenorrhea due to normal physiological circumstances. If no pregnancy exists, further testing is necessary.
Medical history will be collected and a physical exam completed to assess general health and to identify any signs and symptoms that may be related to a possible cause for amenorrhea. A pelvic exam will most likely be done to identify the presence of the pelvic organs and any tumors or cysts.
Blood tests are important in the diagnosis of amenorrhea. Thyroid function tests, FSH, GnRH to LH, and prolactin tests will most likely be done and compared with one another to identify any imbalances. Diagnostic imaging tests may also be done to diagnose any physical abnormalities. Ultrasound is used to evaluate the thyroid and reproductive organs. MRI may be used to visualize the pituitary gland and the hypothalamus. If diagnostic imaging produces no results, a hysteroscopy or laparoscopy may be done to search for any uterine or ovarian abnormalities that cannot be identified using pelvic ultrasound. These are minimally-invasive surgical procedures done by the gynecologist.
Amenorrhea Treatment
The treatment for amenorrhea depends on the cause. Amenorrhea resulting from a hypothalamic condition or polycystic ovarian syndrome may be treated with oral contraceptives in an effort to regulate the menstrual cycle. Hormonal imbalances caused by pituitary and thyroid disorders may be treated with medications. For example, hypothyroidism may be treated with synthetic thyroid hormone to restore the hormonal balance necessary to regulate the menstrual cycle. Certain types of tumors may require biopsy and surgical removal, while others may be treated with medication.
Lifestyle changes may significantly affect the treatment of amenorrhea. Achieving a healthy weight can promote normal hormone levels, as can moderate exercise and a healthy, balanced diet, especially if the cause is polycystic ovarian syndrome. Adopting stress reducing habits and activities may benefit those with hypothalamic amenorrhea.
While the absence of menstruation seems like a welcome experience for many women, in the absence of pregnancy, it is a sign that something is wrong. Women should record the first day of their menstrual periods. The last menstrual period is used to determine the age of a pregnancy and to identify any developmental problems earlier in the pregnancy. If pregnancy does not occur, menstrual period records can be used to determine if there are any important irregularities, and whether there are missed periods.
The identification of amenorrhea may be the first step in identifying a much more important problem. Hormone imbalances involving the thyroid or pituitary gland may be the cause, but tumors in the pituitary gland and hypothalamus can be a much more serious concern. Whether it be for infertility or a brain tumor, amenorrhea should not be taken lightly.
Resources
Reproductive Care Center: Hormone Evaluation
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