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Tests and diagnosis
By Mayo Clinic staffDuring your appointment, your doctor will perform a pelvic exam to check for any problems with your reproductive organs. If you've never had a period, your doctor may examine your breasts and genitals to see if you're experiencing the normal changes of puberty. Amenorrhea can encompass a complex set of hormonal problems. Finding the underlying cause can take time and may require more than one kind of testing.
Lab tests
A variety of blood tests may be necessary, including:
- Pregnancy test. This will probably be the first test your doctor suggests, to rule out or confirm a possible pregnancy.
- Thyroid function test. Measuring the amount of thyroid-stimulating hormone (TSH) in your blood can determine if your thyroid is working properly.
- Ovary function test. Measuring the amount of follicle-stimulating hormone (FSH) in your blood can determine if your ovaries are working properly.
- Male hormone test. If you're experiencing increased facial hair and a lowered voice, your doctor may want to check the level of male hormones in your blood.
Hormone challenge test
For this test, you take a hormonal medication for seven to 10 days to trigger menstrual bleeding. Results from this test can tell your doctor whether your periods have stopped due to a lack of estrogen.
Imaging tests
Depending on your signs and symptoms — and the result of any blood tests you've had — your doctor might recommend one or more imaging tests, including:
- Ultrasound. This painless test uses sound waves to produce images of internal organs. If you have never had a period, your doctor may suggest an ultrasound test to see if all your reproductive organs are present.
- Computerized tomography (CT). 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). MRI utilizes radio waves with a strong magnetic field to produce exceptionally detailed images of soft tissues within the body. Your doctor may order an MRI to check for a pituitary tumor.
Scope tests
If other testing reveals no specific cause, your doctor may recommend a hysteroscopy — a test in which a thin, lighted camera is passed through your vagina and cervix to look at the inside of your uterus.
- Rebar RW, et al. Abnormalities of the reproductive years: Amenorrhea. In: Goldman L, et al. Cecil Medicine. 23rd ed. Philadelphia, Pa.: Saunders Elsevier; 2008. http://www.mdconsult.com/das/book/body/191371208-2/0/1492/0.html#. Accessed March 18, 2011.
- Amenorrhea. National Institute of Child Health & Human Development. http://www.nichd.nih.gov/health/topics/amenorrhea.cfm. Accessed March 18, 2011.
- Martin V, et al. Amenorrhea. In: Bope ET, et al. Conn's Current Therapy. Philadelphia, Pa.: Saunders Elsevier; 2011. http://www.mdconsult.com/books/about.do?eid=4-u1.0-B978-1-4377-0986-5..C2009-0-38984-9--TOP&isbn=978-1-4377-0986-5&about=true&uniqId=236797353-5. Accessed March 18, 2011.
- Heiman DL. Amenorrhea. Primary Care. 2001;36:1.
- Lobo RA. Primary and secondary amenorrhea and precocious puberty: Etiology, diagnostic evaluation, management. In: Katz VL, et al. Comprehensive Gynecology. 5th ed. Philadelphia, Pa.: Mosby Elsevier; 2007. http://www.mdconsult.com/das/book/body/208746819-4/0/1524/0.html. Accessed March 18, 2011.
- Mishell DR. Family planning: Contraception, sterilization and pregnancy termination. In: Katz VL, et al. Comprehensive Gynecology. 5th ed. Philadelphia, Pa.: Mosby Elsevier; 2007. http://www.mdconsult.com/das/book/body/208746819-4/0/1524/0.html. Accessed March 18, 2011.
- Welt CK, et al. Etiology, diagnosis and treatment of secondary amenorrhea. http://www.uptodate.com/home/index.html. Accessed March 21, 2011.
- Welt CK, et al. Etiology, diagnosis and treatment of primary amenorrhea. http://www.uptodate.com/home/index.html. Accessed March 21, 2011.
- Gallenberg MM (expert opinion). Mayo Clinic, Rochester, Minn. March 23, 2011.
- Hysteroscopy. The American Congress of Obstetricians and Gynecologists. http://www.acog.org/publications/patient_education/bp084.cfm. Accessed March 21, 2011.
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