women s health issues
Absence of Menstrual Periods
Evaluation of Amenorrhea
Doctors determine whether amenorrhea is primary or secondary. This information can help them identify the cause. Certain symptoms in girls and women with amenorrhea are cause for concern: Delayed Puberty None Development of masculine characteristics, such as excess body hair, a deepened voice, and increased muscle size Vision problems An impaired sense of smell (which may be a symptom of Kallmann syndrome ) A milky Nipple Discharge that occurs spontaneously (that is, without the nipple's being squeezed or otherwise stimulated) A significant change in weight Girls should see a doctor within a few weeks if They have no signs of puberty (such as breast development or a growth spurt) by age 13. Periods have not started by 3 years after breasts begin to develop. Periods have not started by age 15 in girls who are growing normally and have developed secondary sexual characteristics. Such girls may have primary amenorrhea. If girls or women of childbearing age have had menstrual periods that have stopped, they should see a doctor if they have Missed 3 menstrual periods Fewer than 9 periods a year A sudden change in the pattern of periods Such women may have secondary amenorrhea. Doctors always do a pregnancy test when they evaluate women for secondary amenorrhea. Women may wish to do a home pregnancy test before they see the doctor. Doctors first ask about the medical history, including the menstrual history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of amenorrhea and the tests that may need to be done (see table). For themenstrual history,doctors determine whether amenorrhea is primary or secondary by asking the girl or woman whether she has ever had a menstrual period. If she has, she is asked how old she was when the periods started and when the last period occurred. She is also asked to describe the periods: How many days they lasted How often they occurred Whether they were ever regular How regular they have been in the last 3 to 12 month How heavy they were Whether her breasts were tender or she had mood changes related to periods If a girl has never had a period, doctors ask Whether breasts have started to develop and. if so, at what age Whether she has had a growth spurt and. if so, at what age Whether pubic and underarm hair (signs of puberty) has appeared and. if so, at what age Whether any other family member has had abnormal periods This information enables doctors to rule out some causes. Information about delayed puberty and genetic disorders in family members can help doctors determine whether the cause is a genetic disorder. Doctors ask about other symptoms that may suggest a cause and about use of medications (including prescription and over-the-counter medications, dietary supplements, and opioids), exercise, eating habits, and other conditions that can cause amenorrhea. doctors determine whether secondary sexual characteristics have developed. A breast examination is done. A Pelvic Examination is done to determine whether genital organs are developing normally and to check for abnormalities in reproductive organs. Doctors also check for symptoms that may suggest a cause such as A milky discharge from both nipples: Possible causes include pituitary disorders and medications that increase levels of prolactin (a hormone that stimulates milk production). Headaches, hearing loss, and partial loss of vision or double vision: Possible causes include tumors of the pituitary gland or hypothalamus. Development of masculine characteristics, such as excess body hair, a deepened voice, and increased muscle size: Possible causes include Polycystic Ovary Syndrome (PCOS) , tumors that produce male hormones, and use of medications such as synthetic male hormones (androgens), antidepressants, or high doses of synthetic female hormones called progestins. Hot flashes, vaginal dryness, and night sweats: Possible causes include Premature Menopause , a disorder that causes the ovaries to malfunction, radiation therapy, and chemotherapy. Shakiness (tremors) with weight loss or sluggishness with weight gain: These symptoms suggest a Overview of the Thyroid Gland . Erosion of tooth enamel, enlarged salivary glands in the cheeks (parotid glands), and inflammation of the esophagus: These symptoms suggest an eating disorder, such as Anorexia Nervosa . In girls or women of childbearing age, testing may include A pregnancy test Blood tests to measure hormone levels An imaging test or procedure to examine the reproductive system (such as ultrasonography or hysteroscopy) Sometimes use of hormonal medications to determine whether they trigger a menstrual period A pregnancy test is sometimes done even in girls who have not had a period or reported sexual activity. If pregnancy is ruled out, other tests are done based on results of the examination and the suspected cause. If girls have never had a period (primary amenorrhea) and have normal secondary sexual characteristics, testing begins with hormonal blood tests, a physical examination, and ultrasonography to check for birth defects that could block menstrual blood from leaving the uterus. If birth defects are unusual or difficult to identify, magnetic resonance imaging (MRI) may be done. Tests are usually done in a certain order, and causes are identified or eliminated in the process. If symptoms suggest a specific disorder, tests for that disorder may be done first. For example, if women have headaches and vision problems, MRI of the brain is done to check for a pituitary tumor. Whether additional tests are needed and which tests are done depend on results of the previous tests. Typical tests include Blood tests to measure levels of certain hormones including prolactin (to check for high levels, which can interfere with menstrual periods), thyroid hormones (to check for thyroid disorders), follicle-stimulating hormone (to check for problems with pituitary or hypothalamus function), and male hormones (to check for disorders that cause masculine characteristics to develop) Imaging tests of the abdomen and pelvis to look for a tumor in the ovaries or adrenal glands (usually ultrasongraphy but sometimes computed tomography (CT) or MRI) Examination of chromosomes in a sample of tissue (such as blood) to check for genetic disorders A procedure to view the inside of the uterus or fallopian tubes ( Hysteroscopy or Use of hormones (estrogen and a progestin orprogesterone) to try and trigger menstrual bleeding Forhysteroscopy,doctors insert a thin viewing tube through the vagina and cervix to view the interior of the uterus. This procedure can be done in a doctor's office or in a hospital as an outpatient procedure. Forhysterosalpingography,x-rays are taken after a substance that can be seen on x-rays (a radiopaque contrast agent) is injected through the cervix into the uterus and fallopian tubes. Hysterosalpingography is usually done as an outpatient procedure in a hospital radiology suite. Hormones (progestin or estrogen plus progestin) may be given by mouth to try to trigger menstrual bleeding. If the hormones trigger menstrual bleeding, the cause may be malfunction of the hormonal system that controls menstrual periods or premature menopause. If hormones do not trigger bleeding, the cause may be a disorder of the uterus or a structural abnormality preventing menstrual blood from flowing out. 