HomeAnswersObstetrics and GynecologyamennorheaI am worried about not having periods for two years. Kindly help

What are the causes of amenorrhea in a 18-year-old?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Answered by

Dr. Uzma Arqam

Medically reviewed by

iCliniq medical review team

Published At December 23, 2022
Reviewed AtJune 13, 2023

Patient's Query

Hi,

I am around 18 years old and have not had a period for nearly two years. There is no specific reason for this, and I am questioning whether I need to consult a doctor. I have had no other symptoms other than frequently feeling tired.

Kindly help.

Answered by Dr. Uzma Arqam

Hi,

Welcome to icliniq.com.

Before two years, if you had periods, it is secondary amenorrhea, but if you have not, it is primary amenorrhea. In both cases, you need urgent investigations. Strictly observe for other abnormal symptoms. Discuss with the laboratory and with the gynecologist like changes in voice, abnormal hair growth, and changes in external genitals. Take healthy precautions along with full investigations. If you have been treated for any disease, try to have the full treatment. Let us see your body's response to periods induction as you need to investigate going for blood tests on day two of menstruation. Discuss with the general practitioner before taking the medication. Take Norethindrone 10 mg twice daily for seven days, then wait for withdrawal bleed for a week after the completion of seven days. On the second day of the period, have blood tests (serum testosterone, serum insulin, prolactin, luteinizing hormone, follicular stimulating hormone, serum progesterone, and thyroid function test). A detailed pelvic scan is needed to exclude any pelvic pathology. One local examination by a gynecologist to see any local pathology like an imperforate hymen. After all laboratory results and scans, discuss them with the gynecologist in detail. You need to consult an endocrinologist as well with all your laboratory reports.

Thank you.

The Probable causes

Hormonal imbalance.

Investigations to be done

Serum Progesterone. Serum luteinizing hormone, follicle-stimulating hormone. Serum prolactin. Serum insulin. Thyroid function test. Detailed pelvic scan.

Differential diagnosis

PCOD (polycystic ovarian syndrome) in case of secondary amenohrea

In the case of primary, lots of causes like congenital adrenal hyperplasia,

androgen insensitivity might need a karyotype in the case of primary amenorrhea.

Treatment plan

After completion, based on the investigation reports.

Regarding follow up

Need endocrinologist to follow up with all laboratory reports. Needs a gynecologist follow-up. I want to see her again after 14 days with laboratory reports.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Uzma Arqam
Dr. Uzma Arqam

Obstetrics and Gynecology

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