What tests should be done if menstruation is not coming?

Generally speaking, if menstruation does not come for more than 3 months, after excluding pregnancy, you should go to the hospital in time to find out the cause and treat the symptoms. If you do not take prompt treatment, the longer the amenorrhea lasts, the more severe the uterus and ovaries will shrink, and the worse the treatment effect will be. Therefore, it is recommended that women with such symptoms go to the hospital for the following examinations:

Ovarian function tests: such as endometrial biopsy, vaginal exfoliated cell examination, cervical mucus crystal examination, serum E2 and P measurement, and basal body temperature measurement.

Pituitary function test: Directly measure the levels of blood luteinizing hormone (LH), follicle stimulating hormone (FSH) and prolactin (PRL). If FSH < 40 units/L, it indicates ovarian failure; if PRL > 25 micrograms/L, it indicates hyperprolactinemia. If LH and FSH are at normal or low values, further pituitary stimulation test is required. In the pituitary stimulation test, if the luteinizing hormone (LH) released 15-45 minutes after the injection of luteinizing releasing hormone (LHRH) increases by more than 3 times compared with before the injection, it means that the pituitary responds well to exogenous LHRH, and the cause of amenorrhea is the hypothalamus. If the LH value does not increase or increases slightly after the injection, it means that the lesion is in the pituitary.

Chromosome examination: exclude abnormalities of sexual development.

Ultrasound examination: to find out whether there are polycystic changes in the ovaries.

Laparoscopic examination: to understand the status of gonads and whether there are changes such as dysplasia, polycystic ovary, premature ovarian failure, etc.

CT and MRI examinations: to determine whether there is a pituitary microadenoma.