* A pregnancy test will probably be the first test the doctor not to check the pregnancy as possible.
* Pelvic exam done to check for abnormalities with their reproductive organs.
* Physical exam, including checks indicate that changes must occur at puberty. Drug history will also be discussed.
* Blood tests such as thyroid function test or tests to evaluate the levels of prolactin can reveal a discrepancy in hormone levels, which could be the cause of amenorrhea. If a woman has experienced more than normal hair growth, tests for hormone levels may also be provided.
* Progestin challenge test can also be given. This test involves taking a progestogen or hormonal medicine for 7 to 10 days. This medicine will trigger menstrual bleeding and as a result, your doctor can determine whether your menstrual periods have stopped due to low estrogen levels.
* An imaging test may be given by your doctor after reviewing the symptoms and results of blood tests. Imaging tests such as CT scan (Computerized tomography), MRI (magnetic resonance imaging) or ultrasound can show if there is pituitary tumor or abnormality in the reproductive organs.
* Laparoscopy or hysteroscopy is generally considered a last option when other tests (such as those mentioned above) indicate that there is or is not convincing. Minimal surgery may be recommended by your doctor to view internal organs. Sometimes, problems found during surgery can be treated simultaneously.

Article By Bond Mejeh

Common Causes of Secondary  Amenorrhea - The more common form of secondary amenorrhea is amenorrhea. Possible causes include:

* Pregnancy – the most common of all causes. When women are of reproductive age will most likely be the cause. When a fertilized egg implanted into her uterus wall, keep lining the fetus grows and does not shed through menstruation.
* Contraception – oral contraceptive pill can prevent periods. If a woman uses contraceptives suddenly stops, probably three to six months before he was back to normal ovulation and menstruation. Injected or implanted contraceptives (ie, Depo-Provera or Implanon), also can cause amenorrhea. Progesterone-containing contraceptive device (eg Mirena) may also prevent periods.
* Thyroid damage – a common cause of menstrual irregularities, including amenorrhea. In particular, a thyroid gland which is known as hypothyroidism may be responsible for this. Thyroid damage also may be responsible for the increase or decrease in prolactin production. Reproductive hormone prolactin is produced by your pituitary gland. If the prolactin level is changed, may have influenced the hypothalamus and then interrupt the menstrual cycle.
* Breastfeeding – mothers also experience amenorrhea. Even when still ovulation, menstruation occur is not possible. Consequently, pregnancy may occur because of lack of menstruation occurs.
* Stress – Mental stress can temporarily disrupt normal hypothalamic function. Remember, the hypothalamus is the part of the brain that controls the hormone which is responsible to regulate the menstrual cycle. As a result, ovulation and menstruation may stop. After mental stress subsides. Normal menstrual period should continue.
* Drugs – Anti-depressants, anti-psychotic, some forms of chemotherapy drugs and oral corticosteroids can cause amenorrhea incident.
* Hormonal imbalance – Another common cause of secondary amenorrhea is the abbreviated polycystic ovarian syndrome PCOS. In this case, a woman is experiencing particularly high levels of continuous estrogen and androgen (male hormone). During the normal menstrual cycle, this level should not be maintained but must fluctuate. This result is the reduction of pituitary hormones necessary for ovulation and menstruation. Polycystic ovary syndrome or PCOS associated with obesity, abnormal uterine bleeding and severe acne and sometimes excess facial hair.
* Low weight – Low weight many interruptions hormonal functions in your body, and may be able to stop ovulation. Women who suffer from anorexia or bulimia may stop menstruation due to hormonal change.
* Excessive Exercise – Women who undergo rigorous athletic training, such as distance running, gymnastics or ballet, may experience disruption of their menstrual cycle. This may be due to a combination of factors such as low body fat spending, high energy and stress.
* Pituitary Tumors – A non-benign tumor or cancer of the pituitary gland can cause excess production of prolactin. Higher than normal levels of prolactin can interfere with normal menstruation. This tumor of the pituitary gland can be treated with medication. Only rarely will be required surgery.
* Uterine scarring – also known as Asherman’s syndrome. It is a condition in which scar tissue formed in the lining of the uterus. This can occur after uterine procedures, such as dilatation and curettage, a C-section or cesarean, or treatment for uterine fibroids. Grate prevents buildup and shedding of the uterine lining of the uterus through the menstrual period. Consequently, there may be very light menstrual bleeding or no periods at all.
* Premature Menopause – generally occurs between ages 45 and 55 if. In some women, it can be as early as age 40. When it happened this early, knowing full well as primary ovarian insufficiency. In this condition, there is a lack of ovarian function. This reduces the amount of estrogen circulating in the body. As a result, the uterine lining thins and stops menstruating. Primary ovarian insufficiency may be caused by autoimmune disease or certain genetic factors.

Common Causes of Primary Amenorrhea

* Abnormalities of chromosomes can cause premature decline of eggs in the ovaries and follicles, which play a role in ovulation and menstruation.
* Hypothalamus disorders or functional hypothalamic amenorrhea may cause another. The hypothalamus is located at the base of the brain. Among other things, it controls the hormones responsible for managing the menstrual cycle. Normal function of the hypothalamus may be disturbed by excessive exercise, eating disorders, physical and even psychological stress. This can lead to amenorrhea. Although very rare, tumors can prevent the hypothalamus also functioned normally.
* Pituitary disease or tumor can also inhibit normal pituitary gland function. Pituitary gland is another part of the brain that plays a role in regulating the menstrual cycle.
* Lack of reproductive organs can occur during fetal development. This can cause a girl born without some major parts of the female reproductive system (womb ie, cervix or vagina). Without a well developed reproductive system, menstrual cycle would not be possible.
* Structural abnormality of the vagina or the vaginal walls that prevent the membrane can prevent the signs of menstrual bleeding. A membrane wall such as this can impede blood flow out of the uterus and cervix.

Consultation with a doctor and several tests (pregnancy tests, hormone assay in blood, a physical examination, etc..), Will identify the cause of amenorrhea. The application of preventive measures mentioned above allows the return of menstruation in many women:
- Healthy eating;
- Maintaining a healthy weight;
- Stress Management;
- Moderation in the practice of physical exercises.
Thus, in most cases, medical treatment is not necessary, but it is equally important to identify the cause of amenorrhea, treating the underlying disease as appropriate and of get emotional support when needed.

Medication

Hormonal Treatments
In the case of a malfunction of the ovaries in a young woman, hormone therapy is suggested to occur as the development of sexual characteristics and fertility, and to prevent osteoporosis in the long term.

The arrival of amenorrhea in the menopause can be delayed by a combined hormone replacement therapy (estrogen and progestin), which causes a return or retention of menstruation artificially without restore ovulation. However, with the publication and media coverage of recent studies analyzing the risks of combined hormone replacement therapy at menopause, the current trend in medical circles is to use this treatment only under certain conditions (if symptoms menopause are very bothersome, for example), for a maximum of five years. Thus, women who have mild symptoms will be encouraged to try other means (see description menopause), as those who by their genetics, are at greater risk of cancer.

For women who underwent surgical removal of the uterus and ovaries, hormone therapy with estrogen alone (without progestin) may be taken to prevent osteoporosis and other complications due to lower estrogen levels .

Non-hormonal treatment
Bromocriptine is a drug highly effective in reducing prolactin levels and allows the return of menses.

Surgical treatment
If the delayed puberty is caused by an abnormality of the reproductive tract, surgery may be undertaken.

Psychotherapy
If amenorrhea is accompanied by a neurotic disorder underlying it is possible that the physician provides psychotherapy. The parallel use of estrogen is still recommended.

Amenorrhea associated with anorexia nervosa require mandatory monitoring by a multidisciplinary team including a nutritionist, psychotherapist, psychiatrist, etc.. Victims of this type of amenorrhea are usually young women and even teenagers.

In case of significant psychological trauma (rape, loss of a loved one, accidents, etc..) Or personal conflicts (divorce, financial difficulties, etc..) Amenorrhea for several months or even years, may settle, and this, especially in a woman whose mental balance was fragile. The best treatment is time to consult a psychotherapist.

Caution
If left untreated, amenorrhea long can cause several problems, including infertility.

Complementary

Caution.
Self-treatment of amenorrhea is not recommended. This type of problem, except in cases of delayed puberty, may hide a more serious. Moreover, it is important to rule out the possibility that there is a pregnancy. Several interventions designed to induce menses are not recommended during pregnancy. Consult a physician before starting an unconventional treatment.

The proposed plants are traditionally known to have, after several weeks of treatment, a regulatory effect on the menstrual cycle. However, in general, very few clinical studies have confirmed the existence of such medicinal properties.

Chaste Tree (Vitex agnus castus)
Commission E acknowledges its fruit of chaste tree to treat menstrual irregularities. According to Commission E, in vitro studies and on animals indicate that the compounds chasteberry reduce the production of prolactin by the pituitary gland. However, an excess of prolactin can lead to amenorrhea. One preliminary clinical trial was related 1. During this trial lasting six months, researchers gave 40 drops of extract of chaste tree per day to 20 women with amenorrhea. At the end of the study, 10 of 15 women who continued the treatment until the end were menstruating again.

Angelica (Angelica sp)
In Asia, Chinese angelica (Angelica sinensis) is considered the key remedy to ensure the proper functioning of the female reproductive system. It is used both to treat dysmenorrhea, amenorrhea, menorrhagia the symptoms of menopause for pregnancy support and promote a positive birth. At first glance, the chemical composition of the European species, Angelica archangelica and that of the North American Angelica atropurpurea, is not that different from that of Asian species. Their medicinal properties may however be different. The European species is still traditionally used to trigger menstruation that are slow. The effectiveness of these plants is due to their content of phytoestrogens, compounds that act in the body just like the natural hormones such as estrogen, but with much less power.

Acupuncture
Acupuncturists believe that amenorrhea often be linked to impaired functioning of the Liver and Kidney. Their treatment is mainly to strengthen the functioning of these organs. Acupuncture may also regulate the endocrine functions and help the return of ovulation.

Amenorrhea is the absence of menstruation in a woman of childbearing age. The word “amenorrhea” comes from the Greek for deprivation, men for months and rhein to flow.

From 2% to 5% of the female population would be affected by amenorrhea. This is a single symptom, but it’s reality or origin of disease quite different from each other. In effect, amenorrhea may be quite natural if, for example, the woman is pregnant, breastfeeding or has attained the age of menopause. But it may also be a telltale sign of a health problem underlying more serious, like an eating disorder or endocrine disease.

Every woman is in either of the following is considered amenorrheic and should consult a doctor:

* No menstrual period at age 14 years and lack of development of secondary sexual characteristics (breast development of the pubic hair and armpits and distribution of adipose tissue in the hips, buttocks and thighs);
* No menstrual period at age 16 years and present a development of secondary sexual characteristics;
* A woman has been menstruating, the absence of menstruation for a period of time equivalent to at least three intervals of previous menstrual cycles or six months without menstruation.

Causes

The causes of amenorrhea are numerous. Here are the most frequent.

* Delayed puberty. The age of puberty is normally between 11 and 13 years. Delayed puberty is common among young women who are thin or very athletic. It seems that these young women do not have enough body fat to allow the production of estrogen hormones. Estrogens allow thickening of the uterine wall and subsequent menstruation when the egg was not fertilized by sperm. Somehow, the bodies of these young women are naturally protects and noted that fitness is inadequate to support a pregnancy.
If signs of sexual maturation are still absent at the age of 14 years, one should suspect a chromosomal problem (only one X sex chromosome instead of two, a condition known as Turner syndrome), a problem Development of the reproductive or hormonal problem.
* Pregnancy. The most common cause of amenorrhea, it should be first suspected in a sexually active woman. Surprisingly, it often happens that this case be dismissed without prior verification – which is not without risk. Some treatments indicated for the treatment of amenorrhea-cons are indicated in pregnancy.
* Breastfeeding. Often, women who breastfeed do not menstruate. However, note that they may still have ovulated during this period, and therefore a new pregnancy.
* The arrival of menopause. Menopause is the cessation of menstruation naturally occurring in women aged 45 to 55 years. Estrogen production decreases gradually, so that the periods become irregular, then disappear completely. It can occur sporadically ovulation, and that during the two years following the cessation of menstruation.
* The decision of taking a contraceptive (birth control pills). It is possible that a few months is needed before the normal cycle of ovulation and menstruation is restored. It is called amenorrhea postcontraceptive. This is particularly the case among women with irregular cycles before taking the contraceptive. Furthermore, it is normal for menstruation to cease during the use of contraception, which is administered by injection.
* The practice of a discipline or a demanding sport like marathon running, bodybuilding, gymnastics or ballet career. L ‘gestation of the sport “is due to the lack of fatty tissue and stress which the body is subjected. There is a lack of estrogen in women. It may also be the body to not wasting energy as often undergoes a diet low in calories. Amenorrhea is 4 to 20 times more frequent among athletes than among the population générale1.
* A stress or psychological shock. The so-called psychogenic amenorrhea due to a psychological shock or any other type of stress (travel, major changes in lifestyle, etc..) Which may temporarily affect the functioning of the hypothalamus and cause cessation of menstruation as long as the source of stress persists.
* A rapid weight loss or eating pathology. Body weight too low can lead to a decline in estrogen production and a cessation of menstruation. In the majority of women with anorexia nervosa or bulimia, menstruation stops.
* An excessive secretion of prolactin by the pituitary gland. Prolactin is a hormone that promotes the growth of the mammary gland and lactation. Excessive secretion of prolactin by the pituitary gland may be caused by a small tumor (always benign) or certain medications. Her medical treatment is simple.

Other causes

* Obesity.
* Medications such as oral corticosteroids, antidepressants, antipsychotics or chemotherapy. The drug can also cause amenorrhea.
* Chronic diseases or endocrine. The cystic fibrosis, tuberculosis, diabetes, tumor or an ovarian cyst (or polycystic ovarian syndrome), hyperthyroidism.
* Surgical removal of the uterus or ovaries.

Symptoms

* No menstruation at the age of 14 years and lack of development of secondary sexual characteristics.
* No menstruation at the age of 16 years and present a development of secondary sexual characteristics.
* If a woman has been menstruating, the absence of menstruation for a period of time equivalent to at least three intervals of previous menstrual cycles or six months without menstruation.

NB In case of deficiency of estrogen, there may have hot flashes, mood swings, depression and vaginal dryness.