Not Pregnant, so why no Period?

[Felicia327]

Hi,

Patient is an overweight 43 year old female who hasn't menstruated since February. Pt is completely celibate for the last 5 years. Mother began change of life @ around fifty years old (began missing periods), sister is now age fifty and is starting to miss periods. Client reports having had regular periods all her life except for the last 3 years which she attributes to marital, work and school related stress. Can you ladies and Gents help me with some possible Diagnoses? Note: Patient weighs 325 pounds. Thanks for you help!!

[caroladybelle, BSN, RN]

Marital stress yet "celibate"? Check for pregnancy anyway.

Ovarian cysts, or tumors, not easily palpable in obese pts. Also must rule out other gynecological malignancies or benign masses.

Hormonal abnormalities.

Early menopause.

Stress related ammenorrhea.

As the last two are relatively benign, unless the pt is planning to have children, your priorities are to first rule out pregnancy. Since many tests for the second set of issues (malignancies/masses) are contraindicated in pregnancy, and often require it ruled by testing, it gives you a good reason to tell the pt. Then start investigation for the others.

[Certifiable, BSN, RN]

Even if you patient is overweight- ask her if she's lost any weight recently- that can lead to irregular periods as far as I know...

[Ashkins529]

Another question and it might be irrelevant is, has she started changed her vitamins or added/stopped taking herbal supplements?

[emtbtofuturenurse]

I would definitely think an early menopause or change in thyroid hormones. I wonder if there was an indication of hypothyroidism when the menstrual changes started 3 years prior.

[CrunchyMama, ASN, RN]

I would say hypothyroidism but it could be a number of things. I have hypo and it does effect your periods, fertility and your weight.

[JROregon, ASN, BSN, RN]

Cushings , polycystic ovarian syndrome...

[iPink, BSN, RN]

It definitely could be either thyroid problem (i.e hypothyroidism) or PCOS (Polycystic ovarian syndrome). But, I'm leaning towards PCOS because some of the classic signs are obesity and irregular to no menses. However, these are classic signs of other diseases as well.

[turnforthenurse, MSN, NP]

Even just stress can throw your body out of whack and cause amenorrhea in the absence of pregnancy.

[inthere]

I would think stress, tumor or cyst. She is 43 yrs old and if she had PCOS she would have had it from the beginning of her menses (and would have had issues all her life), not issues beginning @ 43. Her mother went into menopause in her 50's as well as her sister. Pre-menopause usually begins 10yrs prior to actual menopause so I think she is in pre-menopause phase. Since she has been celibate for 5yrs, i think pregnancy is not possible.

[Purple_Scrubs, BSN, RN]

I would think stress, tumor or cyst. She is 43 yrs old and if she had PCOS she would have had it from the beginning of her menses (and would have had issues all her life), not issues beginning @ 43.

This is not necessarily true. One of the hallmark signs of PCOS is irregular or absent menses, but not everyone with PCOS has that symptom. Many women have regular periods and are diagnosed with PCOS later in life based on different symptoms (hirsutism, fertility issues, hormonal imbalances, weight gain, etc.), and for some women symptoms change and/or progress with age, so even if her periods were regular when she was younger, they can become irregular leading to diagnosis of PCOS.

[mengil]

classic pcos