Diagnostic Tests for Amenorrhea
Amenorrhea Tests: Book Excerpts
Home Diagnostic Testing
These home medical tests may be relevant to Amenorrhea:
- Pregnancy -- Related Home Testing:
- Menopause: Related Home Testing:
- Vaginal Health: Home Testing:
- Breast Cancer: Related Home Tests:
Amenorrhea Diagnosis: Book Excerpts
Diagnostic Tests for Amenorrhea: Online Medical Books
16 MEDICAL BOOKS ONLINE!
Review excerpts from medical books online, free, without registration,
for more information about the diagnostic tests for Amenorrhea.
AMENORRHEA:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
The first thing to do is a pregnancy test, as pregnancy is the most common cause of secondary amenorrhea. If the pregnancy test is negative, referral to a gynecologist may be done at this time. If a specialist is not handy, one may proceed with the workup. A trial of medroxyprogesterone acetate (ProveraŽ) may be done by intermuscular injection or by mouth. If bleeding occurs on withdrawal of the progesterone, then it is established that the uterus is functional. It also establishes that the cervix and vagina are patent. If bleeding does not occur, uterine pathology is likely, and referral to a gynecologist is necessary.
If there is no galactorrhea, a normal response to progesterone, and the patient is a teenager, one may simply discontinue studies at this point and observe for the normal onset of the menstrual cycle.
If the patient with primary amenorrhea has already reached her twenties or if there is definite secondary amenorrhea, then further diagnostic studies should be done. If there is galactorrhea, a serum for prolactin should be done. If that is elevated, a CT scan of the brain should be done to look for a pituitary tumor or hypothalamic tumor. If there is no galactorrhea, one should still order a prolactin, but also order tests for follicle-stimulating hormone (FSH), luteinizing hormone (LH), and serum estradiol. If the FSH and LH are elevated and the estradiol is decreased, primary ovarian failure must be considered. A buccal smear for sex chromogens should be done to rule out Turner's syndrome. Other causes of primary ovarian failure are ovarian agenesis and polycystic ovary syndrome. An elevated free testosterone will support the diagnosis of polycystic ovary syndrome (Stein-Leventhal syndrome).
If the FSH, LH, and estradiol are all decreased, then hypopituitarism should be considered, as well as hypothalamic disorders. Referral to an endocrinologist is wise at this point. When an adrenocortical tumor is suspected, a serum cortisol and cortisol suppression test should be done.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Oligomenorrhea:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
After asking the patient’s age, find out when menarche occurred. Has the patient ever experienced normal menstrual cycles? When did she begin having abnormal cycles? Ask her to describe the pattern of bleeding. How many days does the bleeding last, and how frequently does it occur? Are there clots and tissue fragments in her menstrual flow? Note when she last had menstrual bleeding.
Next, determine if she’s having symptoms of ovulatory bleeding. Does she experience mild, cramping abdominal pain 14 days before she bleeds? Is the bleeding accompanied by premenstrual symptoms, such as breast tenderness, irritability, bloating, weight gain, nausea, and diarrhea? Does she have cramping or pain with bleeding? Also, check for a history of infertility. Does the patient have children? Is she trying to conceive? Ask if she’s currently using hormonal contraceptives or if she has ever used them in the past. If she has, find out when she stopped taking them.
Then ask about previous gynecologic disorders such as ovarian cysts. If the patient is breast-feeding, has she experienced problems with milk production? If she hasn’t been breast-feeding recently, has she noticed milk leaking from her breasts? Ask about recent weight gain or loss. Is the patient less than 80% of her ideal weight? If so, does she claim that she’s overweight? Ask if she’s exercising more vigorously than usual.
Screen for metabolic disorders by asking about excessive thirst, frequent urination, or fatigue. Has the patient been jittery or had palpitations? Ask about headaches, dizziness, and impaired peripheral vision. Complete the history by finding out what drugs the patient is taking.
Begin the physical examination by taking the patient’s vital signs and weighing her. Inspect for increased facial hair growth, sparse body hair, male distribution of fat and muscle, acne, and clitoral enlargement. Note if the skin is abnormally dry or moist, and check hair texture. Also, be alert for signs of psychological or physical stress. Rule out pregnancy by a blood or urine pregnancy test.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Amenorrhea:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Begin by determining whether the amenorrhea is primary or secondary. If it’s primary, ask the patient at what age her mother first menstruated because age of menarche is fairly consistent in families. Form an overall impression of the patient’s physical, mental, and emotional development because these factors as well as heredity and climate may delay menarche until after age 16.
If menstruation began at an appropriate age but has since ceased, determine the frequency and duration of the patient’s previous menses. Ask her about the onset and nature of any changes in her normal menstrual pattern, and determine the date of her last period. Find out if she has noticed any related signs, such as breast swelling or weight changes.
Determine when the patient last had a physical examination. Review her health history, noting especially any long-term illnesses, such as anemia, or use of hormonal contraceptives. Ask about exercise habits, especially running, and whether she experiences stress on the job or at home. Probe the patient’s eating habits, including the number and size of daily meals and snacks, and ask if she has gained weight recently.
Observe her appearance for secondary sex characteristics or signs of virilization. If you’re responsible for performing a pelvic examination, check for anatomic aberrations of the outflow tract, such as cervical adhesions, fibroids, or an imperforate hymen.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Oligomenorrhea:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
After asking the patient’s age, find out when menarche occurred. Has the patient ever experienced normal menstrual cycles? When did she begin having abnormal cycles? Ask her to describe the pattern of bleeding. How many days does the bleeding last, and how frequently does it occur? Are there clots and tissue fragments in her menstrual flow? Note when she last had menstrual bleeding.
Next, determine if she’s having symptoms of ovulatory bleeding. Does she experience mild, cramping abdominal pain 14 days before she bleeds? Is the bleeding accompanied by premenstrual symptoms, such as breast tenderness, irritability, bloating, weight gain, nausea, and diarrhea? Does she have cramping or pain with bleeding? Also, check for a history of infertility. Does the patient have any children? Is she trying to conceive? Ask if she’s currently using hormonal contraceptives or if she’s ever used them in the past. If she has, find out when she stopped taking them.
Then ask about previous gynecologic disorders such as ovarian cysts. If the patient is breast-feeding, has she experienced any problems with milk production? If she hasn’t been breast-feeding recently, has she noticed milk leaking from her breasts? Ask about recent weight gain or loss. Is the patient less than 80% of her ideal weight? If so, does she claim that she’s overweight? Ask if she’s exercising more vigorously than usual.
Screen for metabolic disorders by asking about excessive thirst, frequent urination, or fatigue. Has the patient been jittery or had palpitations? Ask about headache, dizziness, and impaired peripheral vision. Complete the history by finding out what drugs the patient is taking.
Begin the physical examination by taking the patient’s vital signs and weighing her. Inspect for increased facial hair growth, sparse body hair, male distribution of fat and muscle, acne, and clitoral enlargement. Note if the skin is abnormally dry or moist, and check hair texture. Also, be alert for signs of psychological or physical stress. Rule out pregnancy by a blood or urine pregnancy test.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Amenorrhea:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Begin by determining whether the amenorrhea is primary or secondary. If it’s primary, ask the patient at what age her mother first menstruated because age of menarche is fairly consistent in families. Form an overall impression of the patient’s physical, mental, and emotional development because these factors as well as heredity and climate may delay menarche until after age 16.
If menstruation began at an appropriate age but has since ceased, determine the frequency and duration of the patient’s previous menstrual cycles. Ask her about the onset and nature of any changes in her normal menstrual pattern, and determine the date of her last menses. Find out if she has noticed any related signs, such as breast swelling or weight changes.
Determine when the patient last had a physical examination. Review her health history, noting especially any long-term illnesses, such as anemia, or use of hormonal contraceptives. Ask about exercise habits, especially running, and whether she experiences stress on the job or at home. Probe the patient’s eating habits, including number and size of daily meals and snacks, and ask if she has gained weight recently.
Observe her appearance for secondary sex characteristics or signs of virilization. If you’re responsible for performing a pelvic examination, check for anatomic aberrations of the outflow tract, such as cervical adhesions, fibroids, or an imperforate hymen.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Amenorrhea:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
The purpose of the focused examination is to screen for abnormal anatomy or development and signs of endocrinopathies. A breast examination should document the presence or absence of galactorrhea which, with hair distribution, should provide an evaluation of normal secondary sexual characteristics (Tanner stage). Palpate the thyroid for enlargement or nodules. A careful pelvic examination is essential to detect any structural abnormalities or lesions. Signs of possible androgenic excess are truncal obesity, hirsutism, acne, male pattern baldness, and clitoral enlargement (Chapter 14.3).
Testing
A. Clinical laboratory tests. Serum or urine human chorionic gonodotropin, thyroid-stimulating hormone, prolactin, follicle-stimulating hormone, and luteinizing hormone are usually the only tests required to make a diagnosis (section V). Additional tests for premature ovarian failure should include free thyroxine (T4), thyroid antibodies, morning cortisol, calcium, phosphorus and antinuclear antibody, rheumatoid factor, erythrocyte sedimentation rate, and a complete blood count. Further adrenal evaluation of women who exhibit signs of hyperandrogenism with anovulation (“hyperandrogenic chronic anovulation”) includes fasting serum testosterone, dehydroepiandrosterone (DHEA)-S, and 17-hydroxyprogesterone (17-HP).
B. Other laboratory evaluation. Karotyping is indicated in all women with premature ovarian failure prior to age 30 years or with any physical evidence suggestive of Turner’s syndrome (short stature, web neck, shield-shaped chest, lack of secondary sexual characteristics) (3). Endometrial biopsy should be considered in women with prolonged amenorrhea or with evidence of estrogen or androgen excess to exclude endometrial hyperplasia.
C. Provocative tests
1. Progesterone challenge test. Oral progesterone acetate (10 mg daily for 15 days). A positive test is withdrawal bleeding between days 2 and 7 after finishing medication; alternatively, parenteral progesterone (200 mg) in oil or micronized progesterone 200 mg at bedtime.
2. Estrogen-progesterone challenge test. Oral conjugated estrogen (1.25 mg) or 2 mg estadiol qd for days 1 through 21 with oral progesterone acetate (10 mg) on days 17 through 21. A positive test is withdrawal bleeding between days 2 and 7 after finishing medication.
D. Diagnostic imaging. A coned lateral view of the sella turcica is indicated as a screening examination for galactorrhea if the prolactin level is less than 100 ng/ml. A magnetic resonance imaging scan, which is more sensitive, is indicated for elevated prolactin, abnormal screening x-ray film, or diagnosis of hypothalamic amenorrhea (section V).
Diagnostic assessment
Use the approach outlined in Figure 11.1 to guide diagnosis (1–3).
References
1. Speroff L, Glass RH, Kase NG. Clinical gynecologic endocrinology and infertility, 5th ed. Baltimore: Williams & Wilkins, 1994:401–456.
2. Kiningham RB, Apgar BS, Swenk TL. Evaluation of amenorrhea. Am Fam Physician 1996;53:1185–1194.
3. Scott J, DiSaia P, Hammond C, Spellacy W, eds. Danforth’s obstetrics and gynecology, 7th ed. Philadelphia: JB Lippincott, 1994:665–679.
4. Alper MM, Garner PR. Premature ovarian failure: its relationship to autoimmune disease. Obstet Gynecol 1985;66:27–30.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Secondary Amenorrhea:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Evaluation should always begin with a history and a urine hCG for pregnancy. On physical examination, attention should be paid to darkening of the areola, and evidence of estrogenization of the vagina.
Estrogen sufficiency can be assessed by observing a fern-like pattern of cervical mucous on a slide or by giving medroxyprogesterone for 5 days and looking for withdrawal bleeding. Bleeding suggests suppression of LH surge as seen in functional amenorrhea or polycystic ovary syndrome.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Oligomenorrhea:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Begin the physical assessment by taking the patient’s vital signs and weighing her. Inspect for increased facial hair growth, sparse body hair, male distribution of fat and muscle, acne, and clitoral enlargement. Note if the skin is abnormally dry or moist, and check hair texture. Also, be alert for signs of psychological or physical stress. Rule out pregnancy by a blood or urine pregnancy test.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Amenorrhea:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Observe her appearance for secondary sex characteristics or signs of virilization. If you’re responsible for performing a pelvic examination, check for anatomic aberrations of the outflow tract, such as cervical adhesions, fibroids, or an imperforate hymen.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Oligomenorrhea:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
After asking the patient's age, find out when menarche occurred. Has the patient ever experienced normal menstrual cycles? When did she begin having abnormal cycles? Ask her to describe the pattern of bleeding. How many days does the bleeding last, and how frequently does it occur? Are there clots and tissue fragments in her menstrual flow? Note when she last had menses.
Next, determine if she's having symptoms of ovulatory bleeding. Does she experience mild, cramping abdominal pain 14 days before she bleeds? Is the bleeding accompanied by premenstrual symptoms, such as breast tenderness, irritability, bloating, weight gain, nausea, and diarrhea? Does she have cramping or pain with bleeding? Also, check for a history of infertility. Does the patient have children? Is she trying to conceive? Ask if she's currently using hormonal contraceptives or if she has ever used them in the past. If she has, find out when she stopped taking them.
Then ask about previous gynecologic disorders such as ovarian cysts. If the patient is breast-feeding, has she experienced problems with milk production? If she hasn't been breast-feeding recently, has she noticed milk leaking from her breasts? Ask about recent weight gain or loss. Is the patient less than 80% of her ideal weight? If so, does she claim that she's overweight? Ask if she's exercising more vigorously than usual.
Screen for metabolic disorders by asking about excessive thirst, frequent urination, or fatigue. Has the patient been jittery or had palpitations? Ask about headaches, dizziness, and impaired peripheral vision. Complete the history by finding out what drugs the patient is taking.
Begin the physical examination by taking the patient's vital signs and weighing her. Inspect for increased facial hair growth, sparse body hair, male distribution of fat and muscle, acne, and clitoral enlargement. Note if the skin is abnormally dry or moist, and check hair texture. Also, be alert for signs of psychological or physical stress. Rule out pregnancy by a blood or urine pregnancy test.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
Amenorrhea:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Begin by determining whether the amenorrhea is primary or secondary. If it's primary, ask the patient at what age her mother first menstruated because age of menarche is fairly consistent in families. Form an overall impression of the patient's physical, mental, and emotional development because these factors as well as heredity and climate may delay menarche until after age 16.
If menstruation began at an appropriate age but has since ceased, determine the frequency and duration of the patient's previous menses. Ask her about the onset and nature of any changes in her normal menstrual pattern, and determine the date of her last menses. Find out if she has noticed any related signs, such as breast swelling or weight changes.
Determine when the patient last had a physical examination. Review her health history, noting especially any long-term illnesses, such as anemia, or use of hormonal contraceptives. Ask about exercise habits, especially running, and whether she experiences stress on the job or at home. Ask about the patient's eating habits, including the number and size of daily meals and snacks, and ask if she has gained or lost weight recently.
Observe her appearance for secondary sex characteristics or signs of virilization. If you're responsible for performing a pelvic examination, check for anatomic aberrations of the outflow tract, such as cervical adhesions, fibroids, or an imperforate hymen.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
"I authorize the release of any medical or other information necessary to process this claim." Do you recognize these words? You should, if...
Germs are a fact of life and catching an infectious disease like a cold may seem inevitable. But there are simple ways to protect yourself against...
Sexual contact can sometimes result in problems. An unwanted pregnancy or sexually transmitted diseases may be some of those consequences. But by...
Sleep is necessary to feel refreshed, but now we know sleep actually impacts the way the body functions. Sleeping poorly can affect how often you get...
See full list of 4 related videos
» Next page: Diagnosis of Amenorrhea
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
