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Expert Q&A

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Should I see a specialist about not having periods?

Asked by Elena, Florida

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I have not had a period for the past five years and before that I had a normal menstrual cycle for 10 years. I went to both my primary care doctor and gynecologist but after the initial blood work and pelvic ultrasound came back normal, it was decided I should go on birth control and stay on it until I reach menopause age. I really don't like the idea of being on birth control for the next 20 years. Is there another specialist I should see or another test I should ask for specifically?

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Living Well Expert Dr. Jennifer Shu Pediatrician,
Children's Medical Group

Expert answer

Thanks for your question. To better help you, I consulted Dr. Gary Glasser of Atlanta Gynecology and Obstetrics in Decatur, Georgia. Glasser shares the following information about prolonged missed periods:

Your concern about your lack of periods (or menses) is understandable, as a monthly cycle is thought by many patients to be "normal," so a lack of them (called amenorrhea) must be "abnormal." Primary amenorrhea means never having a period in the first place, even at an age and stage of development when menses would be expected. Secondary amenorrhea is when three menses have skipped (or six months, whichever is first) in a woman who previously had menstrual cycles.

The most common reason for amenorrhea is pregnancy, which needs to be excluded if a woman is sexually active with males. Following this, an evaluation of the causes for amenorrhea take into account the organs that are responsible for periods in the first place: the ovaries, the uterus, two parts of the brain (the hypothalamus and the pituitary gland), as well as other organs that, when abnormally functioning, can affect the menses, such as the thyroid gland. This type of evaluation generally involves blood tests as well as imaging studies of the reproductive organs and brain if needed.

A careful history and physical exam should be conducted, looking for signs and symptoms (besides amenorrhea) that can occur when the above organs aren't functioning as they should. Abnormal ovarian function can be a result of either polycystic ovarian syndrome, in which ovulation either doesn't occur or occurs irregularly, or a decrease in ovarian function that can present as premature menopause. The uterus can be affected by infection or scarring from uterine surgeries after complicated obstetrical deliveries. The brain can be affected by anorexia, excessive exercise, stress (either emotional or severe illnesses), benign growths in the pituitary gland, or by no apparent precipitating factors at all.

Treatment of secondary amenorrhea depends on the cause. Should amenorrhea be associated with low estrogen levels, the concern is that a woman may be at increased risk for bone thinning and fractures, so estrogen supplementation with oral contraception (a "birth-control pill") is often prescribed, which may be the case in your situation. If there are further questions following the evaluation and treatment by your primary care physician or general gynecologist, a reproductive endocrinologist may be of assistance.

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