Amenorrhea: why there is no menstruation and what to do - examination in Tashkent

Other names: Отсутствие менструаций, первичная аменорея, вторичная аменорея

Amenorrhea is the absence of menstruation for three months or more in a woman who has had a period, or their complete absence by a certain age in a teenager. This is not an independent disease, but a symptom, and anything can be behind it: from pregnancy and a strict diet to a pituitary tumor. Another important thing is that a long absence of menstruation in itself is unsafe for the health of bones and the endometrium.

🧾 МКБ-10: N91 🏥 Where it is treated: 3 A symptom, not a diagnosisFirst thing is a pregnancy testLong absence is unsafe

👨‍⚕️ Which doctor

Gynecologist, endocrinologist

🔬 Diagnostics

HCG, FSH, LH, prolactin, TSH, ultrasound

💊 Treatment

Treatment of the cause, hormonal support

📈 Prognosis

Depends on the reason

⚠️ At risk

Weight loss, stress, sports, PCOS

⏱ When to see a doctor

Examination after 3 months

🚨 See a doctor urgently

With these signs do not wait for a scheduled appointment — the condition requires emergency care.

Головные боли и нарушение зрения — возможна опухоль гипофиза
Выделения of молочных желёз вне беременности
Приливы и ночная потливость в молодом возрасте — возможно истощение яичников
Выраженный дефицит массы тела
Избыточное оволосение и огрубение голоса
Отсутствие менструаций к 15–16 годам
Отсутствие менструаций после родов, выскабливания или гистероскопии

Primary and secondary amenorrhea

Primary - menstruation has not begun by a certain age: by 15–16 years in the presence of secondary sexual characteristics or by 13–14 years in their absence
Secondary - menstruation was present, but stopped for three months or more
Physiological amenorrhea - during pregnancy, breastfeeding and after menopause; does not require treatment

The separation is important because the reasons for these forms are different. With primary amenorrhea, we are often talking about developmental defects, genetic conditions and delayed puberty. In secondary cases - about hormonal disorders, weight changes, stress, PCOS and the consequences of intrauterine interventions.

Causes of secondary amenorrhea

Pregnancy is the most common cause and is the first to be excluded
PCOS
Significant weight loss, strict diets, eating disorders
Intense physical activity, professional sports
Chronic stress and functional hypothalamic amenorrhea
Elevated prolactin, including with pituitary adenoma
Thyroid diseases
Premature ovarian failure - depletion of the egg supply before age 40
Synechia of the uterine cavity after curettage - Asherman's syndrome
Taking hormonal medications, some antidepressants and antipsychotics
Taking anabolic steroids
Chronic diseases, cancer and their treatment
Cushing's syndrome and adrenal disease

Отдельного внимания заслуживает связь веса и цикла. Жировая ткань участвует в обмене половых гормонов, и при её выраженном дефиците организм «выключает» репродуктивную функцию как энергозатратную. Это защитный механизм, и он обратим при восстановлении массы тела.

What are the dangers of prolonged absence of menstruation?

Reduced bone density and risk of osteoporosis - with amenorrhea associated with low estrogen levels
Endometrial hyperplasia - with amenorrhea against the background of PCOS, when there is estrogens, but there is no ovulation and progesterone
Infertility
Cardiovascular risks with long-term estrogen deficiency
Dry mucous membranes and discomfort during sexual activity
Psychological consequences
Missed serious illness: pituitary tumor, premature ovarian failure

Please note an important difference: with low estrogen levels, the main risk is to the bones, with PCOS with normal estrogen and lack of ovulation, the main risk is to the endometrium. Therefore, the tactics in these cases are different.

Survey

Тест на беременность или ХГЧ в крови — обязательный первый шаг
Осмотр гинеколога и УЗИ органов малого таза
ТТГ и пролактин — простые анализы, выявляющие частые и хорошо лечимые причины
ФСГ, ЛГ, эстрадиол — разграничение поражения яичников и центральных нарушений
АМГ и подсчёт антральных фолликулов — оценка овариального резерва
Тестостерон и андрогены при признаках их избытка
Глюкоза, инсулин, липидный профиль при подозрении на СПКЯ
Прогестероновая проба по назначению врача
МРТ гипофиза при значительно повышенном пролактине или неврологических симптомах
Кариотип при первичной аменорее и раннем истощении яичников
Гистероскопия при подозрении на синехии полости матки
Денситометрия при длительной аменорее с дефицитом эстрогенов

Treatment

Treatment is aimed at the cause, and not at artificially inducing menstruation
Restoring body weight when it is deficient is often the only thing required
Reducing the intensity of physical activity and increasing calorie intake in female athletes
Working with stress, normalizing sleep, psychotherapy if necessary
Correction of thyroid function
Treatment of hyperprolactinemia is with medications, and for pituitary adenoma, observation by a neurosurgeon
Weight loss and correction of insulin resistance in PCOS
Cyclic hormone therapy to protect bones and endometrium
Hormone replacement therapy for premature ovarian failure
Hysteroscopic separation of synechiae in Asherman's syndrome
Calcium and vitamin D supplements, load on bones in osteopenia
Stimulation of ovulation when planning pregnancy

Where to get examined in Tashkent

Ultrasound, hormonal laboratory and, if a uterine cause is suspected, hysteroscopy are required.

In Tashkent, such examination and treatment is carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic, if necessary, together with an endocrinologist.

If you haven’t had periods for three months or more, don’t expect it to “recover on its own.” Start with a pregnancy test, and then take TSH and prolactin - these two simple tests identify a large part of the causes that are well treated. Clinic contacts are below.

Services and prices for this diagnosis

Based on official price lists of Tashkent clinics. The exact cost is determined after examination.

🔬 Diagnostics

Первичный приём гинекологаfrom 200 000 Гистероскопия диагностическая (амбулаторно)from 1 475 000 Гистероскопия диагностическая с анестезией (+1 койко-день)from 3 200 000 Пайпель-биопсия эндометрияfrom 525 000

Frequently asked questions: Amenorrhea (lack of menstruation)

After how long after missing a period should I go to the doctor?+

In the absence of menstruation for three months or more, examination is mandatory. But it’s worth contacting earlier if the delay is accompanied by headaches, blurred vision, discharge from the breast, sudden changes in weight, hot flashes, or if you are planning a pregnancy.

Can the cycle disappear due to weight loss?+

Yes, and this is one of the common reasons. With a pronounced deficiency of body weight and adipose tissue, the body perceives the situation as unfavorable for pregnancy and “turns off” the reproductive function. The mechanism is protective and reversible: when weight is restored and nutrition is normalized, the cycle usually returns.

Is it dangerous that I don’t have periods if I don’t plan to have children?+

Yes, regardless of reproductive plans. When estrogen levels are low, bones suffer and the risk of osteoporosis increases. In PCOS, where there is estrogens, but there is no ovulation, the endometrium is not rejected and grows, increasing the risk of hyperplasia. Therefore, the doctor in any case ensures protection of the bones or endometrium.

Can I just induce my period with pills?+

It is possible to artificially induce bleeding, but this is not a cure: the cause remains, and after cancellation the situation repeats. In addition, this approach masks the problem - for example, a pituitary adenoma or premature ovarian failure. First you need to establish the cause.

What is Asherman's syndrome?+

This is the formation of adhesions - synechiae - in the uterine cavity, most often after curettage, complicated childbirth or intrauterine interventions. The endometrium ceases to function normally, menstruation becomes scanty or disappears. The diagnosis is made by hysteroscopy, which simultaneously makes it possible to separate the adhesions.

Can amenorrhea be due to stress?+

Yes, this is called functional hypothalamic amenorrhea. Chronic stress, lack of sleep, intense exercise and poor nutrition suppress the production of hormones that control the ovaries. The condition is reversible, but it requires not only to “calm down”: normalization of nutrition, reduction of stress, and often work with a psychologist are needed.

The information on this page is for reference only and does not replace a doctor consultation. Only a qualified specialist can make a diagnosis and prescribe treatment after an in-person examination.

Where it is treated amenorrhea в Ташкенте

Обследование при аменорее строится по чёткому алгоритму: от исключения беременности к оценке гормонов и состояния матки. В Ташкенте такое обследование, включая гистероскопию при подозрении на синехии, проводят в медицинском центре UROLOGIC COMPLEX и в clinicsе Tashkent Medical Park.