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What Causes Lack Of Menstruation For Many Years?
Question: Dear Doctor,
I'm asking this question on behalf of my beloved cousin. She stopped having her period since the age of 15, and now she is 23 years old. She thinks the amenorrhoea started because she was in very bad mood. She says she doesn't produce estrogen and her prolactin level is high. Apart from those two symptoms she is totally normal. She tried many medications and also traditional herb medicine and found them ineffective. That's all the information I could gather so far. Thank you in advance for helping my cousin out.
Cheers XXXXXXX
I'm asking this question on behalf of my beloved cousin. She stopped having her period since the age of 15, and now she is 23 years old. She thinks the amenorrhoea started because she was in very bad mood. She says she doesn't produce estrogen and her prolactin level is high. Apart from those two symptoms she is totally normal. She tried many medications and also traditional herb medicine and found them ineffective. That's all the information I could gather so far. Thank you in advance for helping my cousin out.
Cheers XXXXXXX
Brief Answer:
Please get blood test done
Detailed Answer:
Hi XXXXXXX
It is very important to understand why her cycles stopped no matter what she thinks.
Taking herbal medicines or hormones is not the solution.
Please follow the advice I am typing below:
1) She needs to get few blood tests done to understand if there is problem with her hormones. Blood tests are : FSH, AMH, TSH, Prolactin.
2) These tests will identify many possibilities. Please send me reports.
3) Is she over weight? What's her height and weight.
Let me know the details requested above so that I can identify the problem
Please get blood test done
Detailed Answer:
Hi XXXXXXX
It is very important to understand why her cycles stopped no matter what she thinks.
Taking herbal medicines or hormones is not the solution.
Please follow the advice I am typing below:
1) She needs to get few blood tests done to understand if there is problem with her hormones. Blood tests are : FSH, AMH, TSH, Prolactin.
2) These tests will identify many possibilities. Please send me reports.
3) Is she over weight? What's her height and weight.
Let me know the details requested above so that I can identify the problem
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you Dr. Koregol,
I really appreciate your promptness in replying me. I have gathered more information from my cousin and I have just uploaded some reports as well. Although the reports are in Chinese, I believe you could identify that the FSH being 5.24 mIU/ml, TSH being 1.72 mIU/L and PRL being 145.62 ng/ml. As for AMH, I don't think she has done that test. But if needed she can have the AMH test done. The only problem is I'm not sure whether she can have the result out before our discussion closes. She said her uterus is quite small and her endometrium is thin.
She is not over weighted, about 165cm tall and 105kg.
The third report I've uploaded is the ultra sound of her uterus. It says:
the front part of the uterus, size: 32.7*19.9mm, shape is normal, echo is even,
endometrium thickness: 1.5mm;
LOV: 25.6*12.3mm, 9-10 follicle can be seen, quite large 5.7*3.4mm;
ROV: 26.3*10.5mm, 9-10 follicle can be seen, quite large 5.8*5.5mm;
CDFI(TAS), scattered blood signal can be seen in myometrium;
Thanks again for helping. Please don't hesitate to let me know if there is anything unclear.
Cheers XXXXXXX
Sorry doctor I made a mistake there. She is 164cm tall and 56kg.
I really appreciate your promptness in replying me. I have gathered more information from my cousin and I have just uploaded some reports as well. Although the reports are in Chinese, I believe you could identify that the FSH being 5.24 mIU/ml, TSH being 1.72 mIU/L and PRL being 145.62 ng/ml. As for AMH, I don't think she has done that test. But if needed she can have the AMH test done. The only problem is I'm not sure whether she can have the result out before our discussion closes. She said her uterus is quite small and her endometrium is thin.
She is not over weighted, about 165cm tall and 105kg.
The third report I've uploaded is the ultra sound of her uterus. It says:
the front part of the uterus, size: 32.7*19.9mm, shape is normal, echo is even,
endometrium thickness: 1.5mm;
LOV: 25.6*12.3mm, 9-10 follicle can be seen, quite large 5.7*3.4mm;
ROV: 26.3*10.5mm, 9-10 follicle can be seen, quite large 5.8*5.5mm;
CDFI(TAS), scattered blood signal can be seen in myometrium;
Thanks again for helping. Please don't hesitate to let me know if there is anything unclear.
Cheers XXXXXXX
Sorry doctor I made a mistake there. She is 164cm tall and 56kg.
Brief Answer:
Polycystic ovaries (PCO) causing amenorrhea
Detailed Answer:
Hi,
Thanks for information.
Her reports seem to be fine with good number of follicles.
Prolactin levels can be reduced by a simple drug called cabergolin and is not a reason for worry.
Her ultrasound report seems fine. She should be able to conceive. Let her get Hysteroscopy test done to assess size of uterus if it is of normal size as I don't see problem with it.
She seems to be having polycystic ovaries ( PCO) which is a common condition affecting young girls and cause amenorrhoea of long duration.
Therefore I see our reason to panic. His has nothing to do with her bad mood.
She can get pregnant and have children in future. As of now no need to worry.
Polycystic ovaries (PCO) causing amenorrhea
Detailed Answer:
Hi,
Thanks for information.
Her reports seem to be fine with good number of follicles.
Prolactin levels can be reduced by a simple drug called cabergolin and is not a reason for worry.
Her ultrasound report seems fine. She should be able to conceive. Let her get Hysteroscopy test done to assess size of uterus if it is of normal size as I don't see problem with it.
She seems to be having polycystic ovaries ( PCO) which is a common condition affecting young girls and cause amenorrhoea of long duration.
Therefore I see our reason to panic. His has nothing to do with her bad mood.
She can get pregnant and have children in future. As of now no need to worry.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. Koregol,
Thanks for your reply. I have translated your message to my cousin. Her reply is as follows:
She had taken cabergolin for a while before, it's just that she forgot to mention that. And it didn't bring her prolactin down to normal level. Also she experienced strong side effect and that's why she stopped taking cabergolin.
A lot of doctors in China also told her that she might have polycystic ovaries (PCO). But after having a color Doppler ultrasound done, she wasn't diagnosed with polycystic ovaries (PCO) by the doctor.
She has also done Computed Tomography（CT) to check prolactinoma. The doctor told her she is totally normal.
Sorry that I didn't gather all the information beforehand. I hope you could still help us as she has been seeing doctors for all those years but couldn't find the cure. As far as she could recall other than being hit by stress (bad mood) and using cold water to wash her hair, there was no apparent reason why her period just stopped suddenly when she was 15.
Look forward to hearing your opinion. Many thanks.
XXXXXXX
Thanks for your reply. I have translated your message to my cousin. Her reply is as follows:
She had taken cabergolin for a while before, it's just that she forgot to mention that. And it didn't bring her prolactin down to normal level. Also she experienced strong side effect and that's why she stopped taking cabergolin.
A lot of doctors in China also told her that she might have polycystic ovaries (PCO). But after having a color Doppler ultrasound done, she wasn't diagnosed with polycystic ovaries (PCO) by the doctor.
She has also done Computed Tomography（CT) to check prolactinoma. The doctor told her she is totally normal.
Sorry that I didn't gather all the information beforehand. I hope you could still help us as she has been seeing doctors for all those years but couldn't find the cure. As far as she could recall other than being hit by stress (bad mood) and using cold water to wash her hair, there was no apparent reason why her period just stopped suddenly when she was 15.
Look forward to hearing your opinion. Many thanks.
XXXXXXX
Brief Answer:
MRI needed
Detailed Answer:
Hi XXXXXXX
Thanks for additional information.
She needs MRI done to identify if there is prolactinoma of pituitary gland.CT scan may not show it.
Please attach Doppler reports ruling out PCOS as there i suspect it is wrong diagnosis and she still has PCO. Please get transvaginal ultrasound scan done in an IVF Centre who are good at identifying PCO.
Please get a consultation with endocrinologist with MRI report to identify the source of high prolactin. There are different combination regimen which will surely help to bring down prolactin levels.
Let me know if you need any more help.
Regards
MRI needed
Detailed Answer:
Hi XXXXXXX
Thanks for additional information.
She needs MRI done to identify if there is prolactinoma of pituitary gland.CT scan may not show it.
Please attach Doppler reports ruling out PCOS as there i suspect it is wrong diagnosis and she still has PCO. Please get transvaginal ultrasound scan done in an IVF Centre who are good at identifying PCO.
Please get a consultation with endocrinologist with MRI report to identify the source of high prolactin. There are different combination regimen which will surely help to bring down prolactin levels.
Let me know if you need any more help.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi Doctor Koregol,
Actually she had done a MRI it's just that she could no longer find the report. Please forgive us of drip feeding you information. She said even the most authoritative endocrinologist in Beijing couldn't see obvious prolactinoma of pituitary gland. She said basically even the best endocrinologist in China couldn't find the reason of her high level of prolactin.
I guess what I'm asking is do you have any suggestions of us going forward? She couldn't find the answer in China that's why she asked me to ask round on English forums to see if there is any other explanation. Sorry for all the hassle. Look forward to your reply.
Cheers XXXXXXX
Actually she had done a MRI it's just that she could no longer find the report. Please forgive us of drip feeding you information. She said even the most authoritative endocrinologist in Beijing couldn't see obvious prolactinoma of pituitary gland. She said basically even the best endocrinologist in China couldn't find the reason of her high level of prolactin.
I guess what I'm asking is do you have any suggestions of us going forward? She couldn't find the answer in China that's why she asked me to ask round on English forums to see if there is any other explanation. Sorry for all the hassle. Look forward to your reply.
Cheers XXXXXXX
Brief Answer:
Take 3 months treatment
Detailed Answer:
Hi XXXXXXX
Thanks for additional information.
Let her take tablet cabergolin 0.5 mg twice a week for 3 months. This is likely to bring down her prolactin levels.
Repeat prolactin levels after 3 months course of treatment to check levels after treatment.
Let me know if you need any more help.
Regards
Take 3 months treatment
Detailed Answer:
Hi XXXXXXX
Thanks for additional information.
Let her take tablet cabergolin 0.5 mg twice a week for 3 months. This is likely to bring down her prolactin levels.
Repeat prolactin levels after 3 months course of treatment to check levels after treatment.
Let me know if you need any more help.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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