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What is Amenorrhoea Profile? 

Amenorrhoea profile is a set of blood tests that are performed to determine the cause for amenorrhoea or the absence of monthly periods. 

The monthly cycle in women starts at puberty (12-14 years of age) and only stops after the age of 50-55 (menopause). Pregnant women also don’t get periods. However, amenorrhea in any other phase of life may be a symptom of an underlying medical condition. 

Amenorrhoea may be due to changes in the hormones, glands and organs that play a role in menstruation. It is of two types – primary amenorrhoea and secondary amenorrhoea. 

Primary amenorrhoea is when a woman does not get her period by the age of 16. It may be due to:

  • Underdeveloped reproductive organs
  • Problems with the secretion of hormones by the pituitary gland and hypothalamus (parts of the brain that produce hormones involved in menstruation)
  • Failure of the ovaries (female sex organs) 

In many cases, the cause for primary amenorrhoea may not be known. 

In secondary amenorrhoea, a woman with normal menses stops getting her monthly period due to any of the following causes:

A woman will also stop getting periods if she has had her ovaries or uterus removed.

For the amenorrhoea profile, the blood levels of the following hormones are tested:

  • LH: LH is an important reproductive hormone secreted by the pituitary gland, a small gland situated in your brain. It helps maintain the function of ovaries and triggers ovulation.
  • FSH: Just like LH, FSH is also secreted by your pituitary gland. It stimulates the growth of eggs in the ovaries and helps in controlling the menstrual cycle. The levels of FSH vary during the menstrual cycle. If the levels are too low or too high, it could lead to menstrual difficulties. FSH also helps in the development of ovaries organs during puberty.
  • Prolactin: Prolactin is yet another hormone that is released by your pituitary gland. It causes the breasts to develop and produce milk for the new-born. In women who are not pregnant, prolactin helps in regulating the menstrual cycle. High prolactin levels may cause amenorrhoea.
  • TSH: The pituitary gland produces TSH, which stimulates the thyroid gland to produce two hormones (T3 and T4) that regulate several body functions. Thyroid is a butterfly-shaped gland present in our neck. If your TSH levels are too high or too low, it can affect your menstrual cycle.

A pregnancy test is also performed with the amenorrhoea profile to rule out pregnancy as a possible cause of the condition.

  1. Why is Amenorrhoea Profile performed?
  2. How do you prepare for an Amenorrhoea Profile?
  3. How is an Amenorrhoea Profile performed?
  4. What do Amenorrhoea Profile results mean?

Your doctor may order this profile to find the underlying causes of amenorrhea. Along with amenorrhoea you may also show some other related symptoms such as:

  • Headache
  • Acne 
  • Extra facial hair
  • Vision changes
  • Changes in breast size
  • Weight gain or weight loss
  • Nausea
  • Vaginal dryness
  • Hair loss
  • Milky discharge from breasts
  • Voice changes

You do not require any special preparation for this profile. Make sure that you inform your doctor if you are taking any herbs, supplements, vitamins or medicines or if you are suffering from any disease. 

Certain drugs like oral oestrogen, hypothyroid medicines and psychiatric drugs may raise the levels of prolactin in your blood. Liver diseases and kidney diseases may also increase your prolactin levels. A blood sample for the prolactin test is usually collected in the morning in a fasting state. 

Drugs that can affect TSH test results include:

  • Phenytoin
  • Phenothiazines
  • Dopamine
  • Glucocorticoids
  • Non-steroidal anti-inflammatory drugs (NSAIDs)
  • Salicylates
  • Furosemide
  • Heparin
  • Enoxaparin
  • Beta-blockers

Inform the doctor if you are on birth control pills or if you are pregnant, as these may affect the test results.

TSH levels can vary during the day. It is preferable to have the test early in the morning.

Wear a short-sleeved t-shirt or shirt so that it is easier to draw a blood sample. 

These tests are performed on a blood sample that is obtained from a vein in the arm. The technician will follow the given procedure to procure the blood sample:

  • He/she will tie a tight band known as a tourniquet around your upper arm and will wipe a site on your arm with an antiseptic. 
  • Using a needle attached to a syringe, the technician will draw a small amount of blood from a vein in your arm. You may experience a pricking sensation when the needle is inserted into the vein. 
  • Once the blood sample is drawn, the technician will release the tourniquet and remove the needle. 
  • He/she will place the blood sample in a labelled bottle and send it to the laboratory for testing.

All blood tests have some associated risks. These include:

Normal results:

Your test results depend on different factors, such as:

  • Gender
  • Age
  • Medical history
  • The method used for the test

The normal ranges of LH in a woman’s body according to the phase of menstrual cycle are as follows:

  • Follicular phase of menstrual cycle: 1.68-15 IU/L (international units per litre)
  • Midcycle peak: 21.9-56.6 IU/L
  • Luteal phase of menstrual cycle: 0.61-16.3 IU/L
  • Postmenopause: 14.2-52.3 IU/L[24]

The normal values for FSH depending on the phase of your menstrual cycle are as follows:

  • Follicular phase of menstrual cycle: 1.4-9.9 IU/mL (international units per millilitre)
  • Ovulatory peak: 6.2-17.2 IU/mL 
  • Luteal phase of menstrual cycle: 1.1-9.2 IU/mL
  • Postmenopause: 19-100 IU/mL[23] 

Normal prolactin levels are less than 20 µg/L (micrograms per litre).

The normal range for TSH is 0.5-5 µU/mL (microunits per millilitre). 

Abnormal results:

Even if your test results are out of the normal range, it may not mean that you have a problem. Discuss your test results with your doctor to know what they mean for you.

  • If your TSH levels are above or below the normal, your doctor may order thyroid function tests and treat the thyroid disorder based on the results. 
  • If you have abnormal FSH, LH and prolactin levels, you may need additional tests.
  • Along with the amenorrhoea profile, the doctor may order other tests like a pelvic ultrasound and magnetic resonance imaging (MRI) of the brain to determine the cause of amenorrhoea.

Some conditions that may cause amenorrhea are as follows:

  • Müllerian agenesis (a condition characterised by a congenital malformation of the genital tract)
  • Complete androgen insensitivity syndrome (a condition characterised by normal breast development, sparse or absent pubic and axillary hair)
  • Primary ovarian insufficiency (a condition characterised by follicle depletion or dysfunction)
  • Turner syndrome (a condition characterised by a webbed neck, a low hairline and cardiac defects)
  • Functional hypothalamic amenorrhea (a condition characterised by insufficient caloric intake with or without an eating disorder, amenorrhea, and low bone density or osteoporosis)
  • Polycystic ovary syndrome 
  • Pregnancy 
  • Contraception (some types like implantable etonogestrel, levonorgestrel-releasing intrauterine devices, etc. may cause amenorrhea)
  • Severe hyperthyroidism
  • An adrenal or ovarian tumour

Disclaimer: All results must be clinically correlated with the patient’s complaints to make a complete and accurate diagnosis. The above information is provided from a purely educational point of view and is in no way a substitute for medical advice by a qualified doctor.

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References

  1. Klein DA, Poth MA. Amenorrhea: An Approach to Diagnosis and Management. Am Fam Physician. 2013 Jun 1;87(11):781-788.
  2. Hormone Health Network [Internet]. Endocrine Society. Washington D.C. US; What is Luteinizing Hormone?
  3. US Food and Drug Administration (FDA) [internet]. Maryland. US; Menopause
  4. Hinkle J, Cheever K. Brunner & Suddarth's Handbook of Laboratory and Diagnostic Tests. 2nd Ed. Philadelphia: Wolters Kluwer Health, Lippincott Williams & Wilkins; c2014. Follicle Stimulating Hormone (FSH), Serum; p. 306–7.
  5. Nemours Children’s Health System [Internet]. Jacksonville (FL): The Nemours Foundation; c2017; Precocious Puberty
  6. Office on women's health [internet]: US Department of Health and Human Services; How will I know if I am starting the transition to menopause?
  7. UF Health [Internet]. University of Florida Health. Florida. US; Follicle-stimulating hormone (FSH) blood test
  8. National Heart, Lung, and Blood Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Blood Tests
  9. UW Health: American Family Children's Hospital [Internet]. Madison (WI): University of Wisconsin Hospitals and Clinics Authority; Follicle-Stimulating Hormone
  10. UF Health [Internet]. University of Florida Health. Florida. US; Turner syndrome
  11. American Society for Reproductive Medicine [Internet]. Alabama. US; Hyperprolactinemia (High Prolactin Levels)
  12. University of Rochester Medical Center [Internet]. Rochester (NY): University of Rochester Medical Center; Thyroid Stimulating Hormone
  13. American Academy of Family Physicians [Internet]. Leawood (KS). US; Amenorrhea
  14. Lobo RA. Primary and secondary amenorrhea and precocious puberty: etiology, diagnostic evaluation, management. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 38.
  15. Bulun SE. Physiology and pathology of the female reproductive axis. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 13th ed. Philadelphia, PA: Elsevier; 2016:chap 17.
  16. Mount Sinai [Internet]. Icahan School of Medicine. New York City (NY). U.S.A.; TSH test
  17. National Health Service [internet]. UK; Blood Tests
  18. You and your Hormones [internet]. Society for Endocrinology. Bristol. U.K.; Luteinising hormone
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