Amenorrhea is the absence of menstruation. Women who do not begin menstruating by the age of 16 have primary amenorrhea. This can be caused by uterine or vaginal malformation, or problems with the pituitary gland, hypothalamus, or thyroid.
Secondary amenorrhea occurs when periods are missed after a woman has begun menstruation. This can occur with excessive exercise, malnutrition, thyroid, ovarian, or other glandular problems.
Amenorrhea is a normal occurrence during pregnancy and breast feeding. It is important to note that the absence of menstruation during breast feeding does not prevent pregnancy.
Whatever the cause of amenorrhea may be, the diagnosis can be a rather involved process. It is important to work with your physician and follow the steps necessary for finding the correct diagnosis for this condition. The following are steps your physician may take to find the cause of amenorrhea.
Pregnancy Testing
Your physician may test your blood to confirm the presence of a pregnancy. Pregnancy is a common cause of missed periods. Unknown pregnancy with an incomplete miscarriage (embryonic death without the uterus expelling the products of conception) can be a cause for several missed periods. It is important to treat this as soon as possible to avoid infection or other problems.
Pelvic Exam
A pelvic examination may be done to identify any vaginal malformations, the presence of the uterus and ovaries, and possibly any tumors that may exist. The manual pelvic exam is useful because some malformations may not be seen using pelvic ultrasound.
Blood Testing
Lab testing may be done for blood hormone levels such as thyroid function tests, FSH (follicle-stimulating hormone), GnRH to LH (gonadotropin-releasing hormone to luteinizing hormone), and prolactin. These tests can detect hormone production problems with the thyroid gland, pituitary gland, and ovaries.
Diagnostic Imaging
A pelvic ultrasound may be done to evaluate the uterus and ovaries for any masses that may be related to amenorrhea. The thyroid gland can also be imaged using ultrasound to find any masses or to identify an abnormal appearance of the thyroid that may be indicative of hypothyroidism or other condition.
Magnetic resonance imaging (MRI) can be used to look for abnormalities with the pituitary gland and hypothalamus. Tumors with either of these organs can affect hormone production that is necessary for regulating the menstrual cycle.
The diagnosis of amenorrhea can be rather involved and complicated and may require several tests to pinpoint the cause. While it can be a frustrating process, it is important to work with your physician so he or she can make the correct diagnosis and prescribe the correct treatment.
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Amenorrhea and Its Significance: Causes of Primary and Secondary Amenorrhea
Amenorrhea Diagnosis and Treatment: Blood Testing, Imaging, and Hormone Regulation
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