Etymology
Amenorrhea comes from the Greek words, a, men, not month, and rhoia, to flow.
Definition
Amenorrhea simply means there is no menses, no period, or the period did not flow for a particular month or duration, etc. The first menses did not occur at an expected age, ie at puberty. Females attain puberty at age 12. But many girls today menstruate earlier, at between age 9 and 13. Some girls menstruate later, at age 15. Some girls and ladies don't have any menses (no periods).
Free Dictionary
What's the problem?
Amenorrhea can occur in many cases. It can occur in female athletes, unmarried girls and married women. There are reasons for amenorrhea to occur. We have to find out why. Amenorrhea affects fertility as it causes infertility. It means females with amenorrhea can't be pregnant and can't have babies in the normal way. It creates a big problem if newly weds want to have a child. Something has to be done about amenorrhea.
How do we know what is what? What can we do to find out?
Check at the nearest clinic. Have a pregnancy test. Have a pelvic examination. Have an ultrasound of the pelvic region. Have a fertility test. Have a genetic test.
Fertility test
This is a panel of hormonal tests performed by the Endocrinology Laboratory at Hospital Universiti Sains Malaysia (HUSM). We call the place the Endocrine Lab for short. The Endocrine Lab is headed by Encik Fadhil. He showed me around and helped with the test requisition form.
The test requisition form must be filled in by the doctor and sent to the Endocrine Lab together with the blood specimen tube. The Endocrine Lab processes the blood to obtain serum.
The test requisition form must be filled in by the doctor and sent to the Endocrine Lab together with the blood specimen tube. The Endocrine Lab processes the blood to obtain serum.
The fertility test is a list of many hormone tests. A single hormone test will require 2 ml of serum (non fasting). A battery of fertility tests requires 5 ml of serum (no fasting is required).
Technically, each test requires 1.5 microlitres serum + 50 microlitres serum for dead space. Thus technically, 52 microlitres serum should suffice for a hormone test on the Cobas series analyzers. The hormone tests on the Cobas e 601 analyzer are immunoassays.
In the Endocrine Lab at HUSM, serum is analysed in the Roche Hitachi Cobas 6000 and Cobas e 601 analyzer system. The turnaround time for the fertility test is 1 week. This means patients can expect to get their fertility test results in 1 week's time.
ENDOCRINE LAB, HUSM
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| Fertility test requisition form, Endocrine Lab, HUSM. 19 Feb 2013 This is the old form. The units used now are expressed differently. |
Screencapture. New units are now used on the requisition form.
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| Roche Hitachi Cobas analyzer system, Endocrine Lab, HUSM. 19 Feb 2013 |
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| Cobas 6000 (left module) and Cobas e 601 (right module), Endocrine Lab, HUSM. 19 Feb 2013 |
Roche Diagnostics
roche-diagnostics-cobas-6000-analyzer-series
http://www.roche.com/index.htm
pregnancy tests
Trigger 1
A 20-year old Malay female had normal developmental milestones. However, unlike her mother and elder sister, she never attained menarche. Her mother attained menarche at age 13 while her sister had hers at age 12. She had completed high school and also obtained a diploma from a private institution. Despite not having any menses, she recently got married to a working man and had sex as part of their marriage (consummated). Now that her marriage is "complete", she wants to have children. However, she is worried about not having any menses at all. So she headed to the nearest family clinic at the hospital in town.
Trigger 2
She complained of never having menses.
On general examination, she looked good and fine. She was tall and slim (height 156 cm, weight 52 kg, BMI 21.4 kg/m2). Her secondary sexual characteristics were well-developed. She had no galactorrhoea.
She had no history of headache, nausea, vomiting, visual disturbance, abdominal pain, and vaginal discomfort before/during/after sex (dyspareunia). She denied having any pain in the vaginal tube.
She was not on any medication or drugs. She did not take any traditional herbal preparation (makjun or herba Melayu). She was social but had never taken any contraceptive.
Examination of the cardiovascular, respiratory and central nervous systems were unremarkable.
Palpation of the abdomen did not reveal any mass. She did not feel any mass in her abdomen either.
She was not involved in strenuous exercise routine, athletic activities or dietary restriction.
Pelvic examination revealed a normal vulva but a short vagina. The cervix and uterus were not palpable.
The doctor ordered a battery of tests to investigate the patient's condition.
A 2-ml blood specimen was sent to the Genetics Centre for chromosome check (Karyotyping).
A 5-ml blood specimen was obtained for fertility testing (hormone testing) by the Endocrine Lab.
She proceeded to the Radiology Department for Ultrasound of her abdomen and IV Urogram.
Laparoscopy was performed by Radiology-O&G-Surgery team.
She was asked to return in a week's time to discuss her test results.
Trigger 3
The results of the investigations were available at her next visit as follows. She came along with her supportive husband.
Karyotype: 46XX
Endocrine (hormone) tests:
Follicle Stimulating Hormone (FSH): 6.4 IU/L (3.5-12.5)
Luteinizing Hormone (LH): 5.0 IU/L (1.0-11.4)
Serum Testosterone: 2.0 nmol/L (0.22-2.9)
Oestrogen: 200 pmol/L (90.1-716)
Prolactin: 200 mIU/L (70-510)
Abdominal Ultrasound:
Ultrasonographic examination showed normal kidneys. However, the uterus was not visible but the ovaries were present.
Urology:
Intravenous urogram was normal.
Laparoscopy:
Fallopian tubes were visualised. They were attached to each other with a fibrous band. The uterus was absent. The ovaries were normal.
The doctor sat down and went through the test results and data interpretation with the couple. She understood what the doctor discussed. The diagnosis was explained to the couple.
Trigger 4
The couple wanted to know more about problems of infertility and the possibility of having a child. She asked if there were options so she could proceed to have at least a child with her beloved husband. The doctor kindly explained and the couple decided to return to try an option to have a baby despite the wife's shortcomings. The couple went home with a dear hope to have a baby some day in the near future.
Acknowledgement: I have modified and remodeled this Case Study based on a PBL (problem-based learning) for Year 3 Medicine for Week 1, O&G Block at the Universiti Sains Malaysia, School of Medicine. I have added more information on the hormone tests and also some material on traditional Malay medicine. I have made this Case Study more self-guided and more approachable for students who prefer to do self-study either before or after the real class PBL (which has 3 triggers). I will do the link-up to various resources when I have time.
http://www.roche.com/index.htm
pregnancy tests
CASE STUDY
A Young Woman Without Menses
Trigger 1
A 20-year old Malay female had normal developmental milestones. However, unlike her mother and elder sister, she never attained menarche. Her mother attained menarche at age 13 while her sister had hers at age 12. She had completed high school and also obtained a diploma from a private institution. Despite not having any menses, she recently got married to a working man and had sex as part of their marriage (consummated). Now that her marriage is "complete", she wants to have children. However, she is worried about not having any menses at all. So she headed to the nearest family clinic at the hospital in town.
Trigger 2
She complained of never having menses.
On general examination, she looked good and fine. She was tall and slim (height 156 cm, weight 52 kg, BMI 21.4 kg/m2). Her secondary sexual characteristics were well-developed. She had no galactorrhoea.
She had no history of headache, nausea, vomiting, visual disturbance, abdominal pain, and vaginal discomfort before/during/after sex (dyspareunia). She denied having any pain in the vaginal tube.
She was not on any medication or drugs. She did not take any traditional herbal preparation (makjun or herba Melayu). She was social but had never taken any contraceptive.
Examination of the cardiovascular, respiratory and central nervous systems were unremarkable.
Palpation of the abdomen did not reveal any mass. She did not feel any mass in her abdomen either.
She was not involved in strenuous exercise routine, athletic activities or dietary restriction.
Pelvic examination revealed a normal vulva but a short vagina. The cervix and uterus were not palpable.
The doctor ordered a battery of tests to investigate the patient's condition.
A 2-ml blood specimen was sent to the Genetics Centre for chromosome check (Karyotyping).
A 5-ml blood specimen was obtained for fertility testing (hormone testing) by the Endocrine Lab.
She proceeded to the Radiology Department for Ultrasound of her abdomen and IV Urogram.
Laparoscopy was performed by Radiology-O&G-Surgery team.
She was asked to return in a week's time to discuss her test results.
Trigger 3
The results of the investigations were available at her next visit as follows. She came along with her supportive husband.
Karyotype: 46XX
Endocrine (hormone) tests:
Follicle Stimulating Hormone (FSH): 6.4 IU/L (3.5-12.5)
Luteinizing Hormone (LH): 5.0 IU/L (1.0-11.4)
Serum Testosterone: 2.0 nmol/L (0.22-2.9)
Oestrogen: 200 pmol/L (90.1-716)
Prolactin: 200 mIU/L (70-510)
Abdominal Ultrasound:
Ultrasonographic examination showed normal kidneys. However, the uterus was not visible but the ovaries were present.
Urology:
Intravenous urogram was normal.
Laparoscopy:
Fallopian tubes were visualised. They were attached to each other with a fibrous band. The uterus was absent. The ovaries were normal.
The doctor sat down and went through the test results and data interpretation with the couple. She understood what the doctor discussed. The diagnosis was explained to the couple.
Trigger 4
The couple wanted to know more about problems of infertility and the possibility of having a child. She asked if there were options so she could proceed to have at least a child with her beloved husband. The doctor kindly explained and the couple decided to return to try an option to have a baby despite the wife's shortcomings. The couple went home with a dear hope to have a baby some day in the near future.
Acknowledgement: I have modified and remodeled this Case Study based on a PBL (problem-based learning) for Year 3 Medicine for Week 1, O&G Block at the Universiti Sains Malaysia, School of Medicine. I have added more information on the hormone tests and also some material on traditional Malay medicine. I have made this Case Study more self-guided and more approachable for students who prefer to do self-study either before or after the real class PBL (which has 3 triggers). I will do the link-up to various resources when I have time.
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