Amenorrhea can result from various causes and the treatment of the condition depends mainly on the cause. Therefore, it is important that the origin of amenorrhea is established during the diagnostic process to ensure that the appropriate and effective treatment is given.
Medical History and Symptoms
During the initial consultation, it is important to discuss the medical history and symptoms that may be associated with amenorrhea and have an impact on the diagnosis. This usually includes questions about reproductive health, sexual relations, nature of previous if any periods and any other particular concerns of the patient.
If a woman with amenorrhea is sexually active, it is worthwhile to conduct a pregnancy test. Pregnancy is a common cause amenorrhea and should always be considered in sexually active women, even if they use contraceptive methods.
A physical examination of the body, including other signs of sexual development, such as breast enlargement and pubic hair growth, is also useful.
Laboratory examination of a blood sample is useful in the diagnosis of amenorrhea, as it can help to understand any hormonal imbalances that may be associated with the condition.
Blood tests can assist in monitoring:
- Thyroid function: based on level of thyroid stimulating hormone (TSH)
- Ovary function: based on level of follicle stimulating hormone (FSH)
- Pituitary function: based on level of prolactin hormone
- Androgenic hormones, such as testosterone
Other Diagnostic Tests
Other diagnostic tests that may help include imaging tests such as:
- Ultrasound imaging
- Computed tomography (CT) scan
- Magnetic resonance imaging (MRI)
If a lack of estrogen is suspected as a cause of amenorrhea, a hormone challenge test may be indicated. This involves administration of a hormonal medication to induce menstrual bleeding.
Finally, a hysteroscopy may be recommended if the cause remains unidentified after other diagnostic testing methods. This involves the insertion of a camera into the uterus via a thin line through the vagina and cervix and allows the area to be viewed for any causative abnormalities.
Some women may have amenorrhea due to excessive physical activity and strict eating restrictions. If this is the case, alterations to lifestyle to allow the body to recover are recommended. This should include a healthy, balanced diet and regular light exercise that doesn’t put too much strain on the body.
In many cases, the oral contraceptive pill or other hormonal treatments can help to initiate menstruation. This normalizes hormone levels in the body and stimulates ovulation and menstruation as usual. Metformin, a drug commonly used in the treatment of type 2 diabetes mellitus, can also help to support ovulation.
If a disorder of the thyroid or pituitary gland is established as a likely cause of the condition, specific medications may be required to boost the hormones produced by these endocrine glands. The change in the level of these hormones may then have an effect on the production of estrogen and progesterone and normal menstrual periods may recommence.
If there is a structural abnormality or tumor that affects the function of an endocrine gland or the reproductive system, surgery may be required to correct this to treat amenorrhea. Medications are sometimes able to shrink tumors, but surgical removal and targeted radiotherapy may be required.
Counseling and Support
It is important that women with amenorrhea have adequate support throughout the treatment process. It can be a difficult time for many affected women, as they may feel that their body is abnormal and have difficulty coming to terms with this. For this reason, a strong support network is the key to recovery and reassurance that treatment can help to restore regular menstrual periods.
Reviewed by Jonas Wilson, Ing. Med.