A health care provider will usually ask a series of questions to begin diagnosing amenorrhea, including:1
- How old were you when you started your period?
- What are your menstrual cycles like? (What is the typical length of your cycle? How heavy or light are your periods?)
- Are you sexually active?
- Could you be pregnant?
- Have you gained or lost weight recently?
- How often and how much do you exercise?
If you are older than 16 and have never had a period, your health care provider will do a thorough medical history and physical exam, including a pelvic exam, to see if you are experiencing other signs of puberty. Depending on the findings and on your answers to the questions above, other tests may be ordered to determine the cause of your amenorrhea.
If you are sexually active, your health care provider will likely order a pregnancy test. He or she will also perform a complete physical exam, including a pelvic exam.
You should contact your health care provider as soon as possible after you miss a period.
- Thyroid function test.1,2,3 This test measures the amount of thyroid-stimulating hormone (TSH) in your blood, which can help determine if your thyroid is working properly. A thyroid gland that is overactive (hyperthyroidism) or underactive (hypothyroidism) can cause menstrual irregularities, including amenorrhea.
- Ovary function test.1,2,3,4 This test measures the amount of follicle-stimulating hormone (FSH) or luteinizing hormone (LH)—hormones made by the pituitary gland—in your blood to determine if your ovaries are working properly. Your health care provider may also evaluate the level of anti-Mullerian hormone (AMH), which is produced by the ovarian follicles. Higher levels of AMH may be associated with polycystic ovary syndrome (PCOS).4 Low or undetectable amounts of AMH may be associated with menopause or primary ovarian insufficiency.
- Androgen test.1,2,3 Androgens are sometimes called "male hormones" because men need higher levels of these hormones than woman do for overall health. However, both men and women need androgens to stay healthy. Your health care provider may want to check the level of androgens in your blood.
- High levels of androgens may indicate a woman has PCOS.1,2,3
- Hormone challenge test.1,2,3 With this test, you will take a hormonal medication for seven to 10 days in an effort to trigger a menstrual cycle. Results from the test can tell your health care provider whether your periods have stopped because of a lack of estrogen.
- Screening for a premutation of the FMR1 gene.5 Changes in this gene can cause the ovaries to stop functioning properly, leading to amenorrhea.
- Chromosome evaluation.1,2,3 This test, also known as a karyotype, involves counting and evaluating the chromosomes from cells in the body to identify any missing, extra, or rearranged cells. Results from this evaluation can help determine the cause of the chromosomal abnormality causing primary or secondary amenorrhea.
- Ultrasound.1,2,3 This painless test uses sound waves to produce images of internal organs. This test can help determine if your reproductive organs are all present and shaped normally.
- Computed tomography (CT).1,2,3 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).1,2,3 MRI uses radio waves with a strong magnetic field to produce detailed images of soft tissues within the body. Your health care provider may order an MRI to check for a pituitary tumor or to examine your reproductive organs.
- Hysteroscopy.1,2,3 In this procedure a thin, lighted camera is passed through your vagina and cervix to allow your health care provider to look at the inside of your uterus.
Your health care provider might use several of these tests to attempt to diagnose the cause of amenorrhea. In some cases, no specific cause for the amenorrhea can be found. This situation is called idiopathic (pronounced id-ee-uh-PATH-ik) amenorrhea.6
- Master-Hunter, T., & Heiman, D. L. (2006). Amenorrhea: Evaluation and treatment. American Family Physician, 73, 1374–1382. Retrieved May 31, 2016, from http://www.aafp.org/afp/2006/0415/p1374.html
- American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins—Gynecology. (2013). Practice bulletin no. 136: Management of abnormal uterine bleeding associated with ovulatory dysfunction. Obstetrics and Gynecology, 122(1), 176–185.
- Practice Committee of the American Society for Reproductive Medicine (PC-ASRM). (2008). Current evaluation of amenorrhea. Fertility and Sterility, 90, S219–225. Retrieved May 31, 2016, from http://www.asrm.org/uploadedFiles/ASRM_Content/News_and_Publications/Practice_Guidelines
/Educational_Bulletins/Current_evaluation(1).pdf (PDF - 146 KB)
- Visser, J., de Jong, F. H., Laven, J., & Themmen, A. (2006). Anti-Mullerian hormone: A new marker for ovarian function. Reproduction, 139, 1–9. Retrieved May 31, 2016, from http://www.reproduction-online.org/content/131/1/1.long
- NIH. (2008). NIH research plan on Fragile X syndrome and associated disorders. Retrieved May 31, 2016, from http://www.nichd.nih.gov/publications/pubs/Documents
/NIH_Research_Plan_on_Fragile_X_and_Assoc_Disorders-06-2009.pdf (PDF - 439 KB)
- Warren, M. P., & Fried, J. L. (2001). Hypothalamic amenorrhea. The effects of environmental stresses on the reproductive system: A central effect of the central nervous system. Endocrinology & Metabolism Clinics of North America, 30, 611−629. Retrieved May 31, 2016, from http://www.ncbi.nlm.nih.gov/pubmed/11571933