Diagnosis starts with a medical history and a complete physical exam, including a pelvic exam to check for any problems with your reproductive organs. Your healthcare provider will want to rule out other menstrual disorders, medical conditions, or medicines that may be causing or aggravating the condition. A diagnosis of amenorrhea means that you miss at least 3 periods in a row, without being pregnant.
Young women who haven’t had their first menstrual period by age 15 should be evaluated promptly. Making an early diagnosis and starting treatment as soon as possible is very important.
Amenorrhea can indicate a complex set of hormonal problems. Finding the underlying cause can take time and may require more than one kind of testing. Your doctor may recommend one or more of the following:
A variety of blood tests may be necessary to test for hormonal insufficiency.
- Pregnancy tests are used first to rule out or confirm a possible pregnancy.
- Thyroid function tests measure the amount of thyroid-stimulating hormone (TSH) in the blood and determine if the thyroid is working correctly.
- Ovarian function tests measure the amount of follicle stimulating hormone (FSH) in the blood to check for ovarian failure or ovarian insufficiency, meaning the ovaries are not working correctly.
- Prolactin tests check that your levels of the hormone prolactin are normal or not. A low level of prolactin can indicate problems with the pituitary gland such as a pituitary gland tumor.
- Male hormone tests check the amount of male hormones in the blood. If you have increased facial hair and lowered voice, it may indicate a hormone imbalance and that there is excess Testosterone being produced.
Depending on your symptoms and the results of your bloodwork, your doctor may also recommend some imaging tests to differentiate your diagnosis. These tests may include:
Magnetic resonance imaging (MRI), which uses radio waves to produce detailed images of the body’s soft tissues. This test is usually used if your doctor suspects a pituitary tumor may be the cause of your amenorrhea.
An ultrasound, which uses sound waves to make images of the internal organs. This is usually recommended for those who have never had a period, so your doctor can check for any reproductive organ abnormalities.
Hormone challenge test
Your doctor may suggest you take a 7-10 day regimen of hormone therapy to trigger menstruation. This can help your doctor learn if your amenorrhea is caused by a lack of estrogen.
If the above tests do not indicate what may be causing your amenorrhea, a hysteroscopy may be recommended.
In this test, a slim camera and light are passed through the vagina and cervix to examine the inside of the uterus to check for complications such as uterine fibroids.