Amenorrhoea Profile

What is Amenorrhoea?

Amenorrhoea is the absence of or the abnormal stopping of menstruation (monthly periods) in a girl or woman. It is divided into two types: Primary amenorrhoea that occurs before the first menstrual period in female adolescents and is the failure to start menstruating, and Secondary amenorrhoea that occurs after the first menstrual period and is the cessation of periods that were regular or irregular.

More specifically, primary amenorrhoea is when a girl has (1) not started to menstruate by the age of 13 years and has no secondary sexual characteristics (e.g., breast development); (2) not started to menstruate by the age of 15 years and has normal secondary sexual characteristics; or (3) has not started to menstruate within 3 years of the start of breast development, or within 5 years if breasts started to develop before the age of 10. Secondary amenorrhoea is when a woman who has previously been menstruating (1) misses 3 periods in a row; or (2) does not have a period for 6 months or more.

There are several causes of amenorrhoea, including abnormalities of the genital outflow tract, primary ovarian insufficiency (POI), disorders of the brain’s hypothalamus, the pituitary gland, or other endocrine (hormone-producing) glands, and physiological causes.

Can I buy a test for amenorrhoea online?

Yes. The Online Clinic offers a test with 6 hormone biomarkers to help explain the reason for amenorrhoea.

What is an Amenorrhoea Profile?

An Amenorrhoea Profile measures the level of six hormones and calculates an index related to female fertility and reproduction. The components and their role are:

• Luteinising Hormone (LH): a sex hormone produced by the anterior pituitary gland that triggers egg release (ovulation) from the ovary. It regulates the menstrual cycle; triggers the ovaries to produce steroid hormones (androgens, oestrogen, and progesterone); and has a role in egg implantation in the uterus.
• Follicle Stimulating Hormone (FSH): a sex hormone also produced by the anterior pituitary gland that stimulates growth and maturation of follicles (containing eggs) in the ovary and prepares the eggs for ovulation.
• Prolactin: a hormone produced by the anterior pituitary gland that stimulates the mammary glands (breasts) to start milk production and to maintain production during pregnancy and breastfeeding.
• Testosterone: a sex hormone produced in the ovaries, where it is converted to oestradiol. It is the primary androgen, is regulated by LH and FSH, and its production and conversion to oestradiol are essential for ovulation.
• Oestradiol-17-beta: a sex hormone produced mainly in the ovaries and is the main form of oestrogen. During a normal menstrual cycle, oestradiol levels increase before ovulation. After ovulation, lower levels are maintained and then fall if pregnancy does not occur, enabling the next menstrual cycle to begin.
• Sex Hormone Binding Globulin (SHBG): a protein produced in the liver that binds to sex hormones (mainly testosterone, dihydrotestosterone [DHT], and oestradiol). It transports these hormones in an inactive form in the blood and controls the level of active hormone available to tissues.
• Free Androgen Index (FAI): investigates women for suspected hyperandrogenism, which occurs when levels of androgens (e.g., testosterone and DHT) are high. FAI is calculated by Total Testosterone/SHBG x 100%.

How long do results take for the Amenorrhoea test profile?

Results are back within 1 day of the sample arriving at our laboratory. A doctor will interpret your results for you as part of the service.

Why is an Amenorrhoea Profile important?

An Amenorrhea Profile helps to identify the underlying cause of why monthly menstrual periods are absent or have stopped. It measures blood levels of key hormones associated with fertility and reproduction, to determine whether the cause(s) is due to hormone imbalances, dysfunctional ovaries, or a pituitary condition.

The Profile (1) distinguishes between different causal conditions, e.g., POI, polycystic ovary syndrome (PCOS), or functioning of the brain’s hypothalamus (functional hypothalamic amenorrhea); (2) assists in excluding serious conditions e.g., structural abnormalities and tumours; and (3) can indicate treatment to improve fertility and prevent osteoporosis.

Who should have their Amenorrhoea Profile investigated?

An Amenorrhoea Profile should be investigated in girls and women with an absence or disruption of their menstrual cycle.

Additionally, women should consider a Profile evaluation if they experience signs such as excess facial/body hair, severe acne, weight gain, unexplained headaches, visual changes, unexplained tiredness, a history of excessive exercise, an eating disorder or significant weight loss, difficulty conceiving, or they have had a pelvic infection or recent surgery of the uterus or cervix. These signs can indicate causes such as a hormone imbalance; hypothalamic or pituitary problems; POI, PCOS, infertility, or lifestyle factors.

The Profile helps doctors to determine the cause of amenorrhea so that the appropriate treatment can be started, the normal cyclic pattern of menstruation can be restored, and/or the underlying problem can be managed.

How to investigate an Amenorrhoea Profile?

Before having an Amenorrhoea Profile, pregnancy and breastfeeding should be excluded. The amenorrhoea Profile requires the measurement of levels of LH, FSH, prolactin, testosterone, oestradiol-17-beta, and SHBG in a small sample of blood. The FAI will be calculated from the testosterone and SHBG levels.

The blood sample can be collected either from a vein in your arm by a healthcare professional at a clinic or The Online Clinic can send you a pack containing all that is needed to perform a finger-prick blood test at home.

The method of self-blood collection is demonstrated using the easy-to-follow, step-by-step pictorial instructions provided. Details of where to send the self-collected blood sample for laboratory analysis are also included in the pack. The Profile results are sent to The Online Clinic and a doctor will explain the findings to you.

The Online Clinic doctor may ask you for details about your puberty development, signs of menopause, age of menopause in family members, contraceptive use, medications and treatments, chronic disease, weight loss, exercising, stress, depression, weight loss, disturbance of perception of weight or shape, level of exercise, headaches, ache, excess body hair, and genetic anomalies.

What are normal Amenorrhoea Profile results?

Normal blood levels of the hormones making up the Amenorrhoea Profile differ with age, medical history, and medicines, and test methods and reference values may vary among different laboratories.

Depending on your results, you may be asked to have a thyroid function test because the thyroid gland has an important role in regulating hormones that control menstruation and fertility. An underactive thyroid gland can lead to heavy bleeding, irregular cycles, and longer periods, whereas an overactive thyroid can lead to light/missed bleeding and short cycles.

How to maintain a normal Amenorrhoea Profile?

A healthy lifestyle supports good body functioning, including menstruation and overall fertility and reproductive health. This includes a well-balanced diet, regular physical activity (not excessive), maintaining a healthy body weight, limiting alcohol consumption, smoking cessation, having a good sleep routine, and avoiding excess stress, recreational drugs, sexually transmitted diseases.

However, amenorrhoea can be managed and treatment will depend on the cause of the missing menstrual periods. Referral is usually to a paediatrician (a children’s doctor; primary amenorrhoea only), gynaecologist (doctor focusing on female reproductive health), or endocrinologist (doctor treating hormone imbalances and gland diseases), or the condition will be manged by the general practitioner (secondary amenorrhoea only). Amenorrhoea resulting from weight loss, over-exercising, chronic illness or stress, referral is usually first made to an endocrinologist (to eliminate a problem with the hypothalamus or pituitary gland) and then to specialist service where necessary. To prevent bone loss, treatment for osteoporosis may be started if amenorrhoea lasts for more than 6 months.

References

Atukorala KR, Silva W, Amarasiri L, et al. Changes in serum testosterone during the menstrual cycle – an integrative systematic review of published literature. Gynecological and Reproductive Endocrinology & Metabolism. 2022;3:009-020. Available from: https://gremjournal.com/journal/01-2022/changes-in-serum-testosterone-during-the-menstrual-cycle-an-integrative-systematic-review-of-published-literature/

Cabrera-Reyes EA, Limón-Morales O, Rivero-Segura NA, et al. Prolactin function and putative expression in the brain. Endocrine. 2017;57:199-213. Available from: https://pubmed.ncbi.nlm.nih.gov/28634745/

Cleveland Clinic. Follicle-stimulating hormone (FSH). Last updated 23 Jan 2023. Available from: https://my.clevelandclinic.org/health/articles/24638-follicle-stimulating-hormone-fsh Accessed 09 May 2026.

Gloucestershire Hospitals NHS Foundation Trust. Oestradiol. Available from: https://www.gloshospitals.nhs.uk/our-services/services-we-offer/pathology/tests-and-investigations/oestradiol/ Accessed 10 May 2026.

Gloucestershire Hospitals NHS Foundation Trust. Sex Hormone Binding Globulin (SHBG). Available from: https://www.gloshospitals.nhs.uk/our-services/services-we-offer/pathology/tests-and-investigations/sex-hormone-binding-globulin-shbg/ Accessed 10 May 2026.

Gloucestershire Hospitals NHS Foundation Trust. Free Androgen Index (FAI). Available from: https://www.gloshospitals.nhs.uk/our-services/services-we-offer/pathology/tests-and-investigations/free-androgen-index-fai/ Accessed 10 May 2026.

Klein DA, Poth MA. Amenorrhoea: An approach to diagnosis and management. American Family Physician 2013;June 1. Available from: https://www.aafp.org/pubs/afp/issues/2013/0601/p781.html

LiverTox®: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012–. Gonadotropins. Updated 2018, Mar 26. Available from: https://www.ncbi.nlm.nih.gov/books/NBK548856/

Nedresky D, Singh G. Physiology, Luteinizing Hormone. Updated 2022, Sep 26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2026 Jan–. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539692/

Nelson LM. The truth about 17-beta estradiol: menopause beyond “old wives’ tales”. Front Endocrinol (Lausanne). 2023;14:1229804. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10520270/

NICE. When should I suspect primary amenorrhoea? Last revised February 2024. Available from: https://cks.nice.org.uk/topics/amenorrhoea/diagnosis/when-to-suspect-primary-amenorrhoea/

NICE. When should I suspect secondary amenorrhoea? Last revised February 2024. Available from: https://cks.nice.org.uk/topics/amenorrhoea/diagnosis/when-to-suspect-secondary-amenorrhoea/

South Tees Hospitals NHS Foundation Trust. Oestradiol. Available from: https://www.southtees.nhs.uk/services/pathology/tests/oestradiol/ Accessed 10 May 2026.

South Tees Hospitals NHS Foundation Trust. Sex Hormone Binding Globulin. Available from: https://www.southtees.nhs.uk/services/pathology/tests/sex%20hormone%20binding%20globulin/ Accessed 10 May 2026.