Q: My sister, aged 19 years, has not yet started her periods. Is it a case of amenorrhea? She is being treated for the last two and half years but in vain. A scan was done on which it was found that her ovaries are of normal size but the uterus is slightly smaller than usual. So please let me know how can it be treated?

A:She heeds a complete evaluation of hormone estimations like thyroid, prolactin, FSH and LH. Besides this a karyotype to see any defect. There can be many causes of absent menses and investigations are done stepwise to locate cause - the scan shows a normal sized uterus and ovary indicating normal structure - but hormone function needs evaluation. If all above tests are normal - tubercular infection needs to be ruled out by an ESR and Mantoux test. A hormone progesterone challenge treatment to bring about menses is necessary. After that if the menses comes - treatment with cyclical hormones can be started for 6-9 months. If there is no menses with progesterone alone - then combination of oestrogen and progesterone challenge is done and treatment according to response. Treatment is also by the cause found. Please consult an endocrinologist as well.