While not having a period can feel easier, you may worry whether something has gone wrong in your body. Not all amenorrhea arises from the same cause, and there are cases that are not explained by one ultrasound or a hormone level alone. This looks at the flow of care when a person who was already having periods does not have a period for several months.
Why is pregnancy status checked first?
Even if you have usually used contraception, the possibility of pregnancy should be looked at first. If the timing of the test is early, or if the situation makes it difficult to judge from a urine test alone, a repeat test or a blood test is considered. Please tell us the start date of your last period, recent sex, and your method of contraception.
Even when there is a reason periods might change, such as breastfeeding or using hormonal contraception, it still needs to be confirmed whether the current change is explained by that reason. Menopause, too, is judged by putting together several pieces of information, including age and how long periods have been absent, and it is not concluded from several months without a period alone.
What records are helpful to prepare before the visit?
- Period record: Write down the last start date, how regular previous cycles were, and the usual amount of bleeding.
- Body and lifestyle changes: Please tell us about weight change, limiting how much you eat, exercise intensity, and changes in stress and sleep.
- Medicines and treatment: List your contraceptive pills or devices, prescription medicines and supplements, and any recent procedures inside the uterus or pregnancy-related care.
- Symptoms that came with it: Describe milky breast discharge, headache and changes in vision, sensitivity to heat and to cold, changes in hair and skin, and so on.
Just because there is exercise or a weight change, the cause is not put down to a single lifestyle habit. A state of insufficient energy intake needs to be distinguished from other hormone or uterine problems, and you do not need to overeat on purpose or suddenly increase exercise for the evaluation.
What do blood tests and ultrasound look at?
After pregnancy status is checked, thyroid function, prolactin, hormones related to ovarian function, and similar tests can be reviewed. Results are interpreted together with symptoms, medicines taken, and the conditions of the test, and if a temporary change is suspected they may be checked again.
Ultrasound is used to look at structures inside the pelvis, such as the endometrium and the ovaries. The route of the examination is explained and decided according to what is needed and your own situation. Not every hormone test or detailed imaging test is done at one time for every person. From one particular finding alone, a diagnosis is not confirmed and the future possibility of pregnancy is not decided.
Will just bringing on a period solve it?
Bleeding after a medicine is used does not mean that the cause has all been resolved. Management differs according to the cause that was found, such as a thyroid or prolactin problem, insufficient energy, a change in ovarian function, or a problem inside the uterus. When needed, effects on bone health or the endometrium are looked at as well.
Rather than obtaining a hormonal medicine on your own and taking it, first confirm the reason for the tests and the goal of treatment. Depending on the medicine, there are side effects such as a change in bleeding, headache, and nausea, and there are restrictions on use, so it is best to tell us your existing conditions and the medicines you take and to set a plan.
You can check the consultation content in Guide to irregular periods and amenorrhea. For the timing of evaluation and the flow of tests, the American Society for Reproductive Medicine guidance on evaluating amenorrhea was referred to, and for cycle records and related changes, the NHS irregular periods guidance was referred to.