1. Brain MRI with contrast dedicated to the pituitary gland: A Brain MRI is an imaging procedure, where you will lie very still while in a tube-like machine, where magnets will create a very precise image of your brain. This is done to rule out a tumor in the hypothalamus area or in the pituitary gland. The most common tumors found in the brain that would give symptoms of amenorrhea, oligomenorrhea or irregular periods are called prolactinomas. These are benign tumors (not cancerous) and the often secrete the hormone prolactin. This is one of the reasons why I will check prolactin levels in your blood. Also, during our fist visit, when a comprehensive history is taken, I will ask you questions that may lend weight to the thought that your prolactin may be high.
2. DEXA Scan (Dual-energy X-ray absorptiometry): A DEXA scan is an imaging study in which you will lie in an open flat table. Two X-ray beams, with different energy levels (ie: "duel") are used to create an image of the patients bones. Generally, bones measured are hip, wrist and spine and matched to normal bone density levels for a woman of our age, height, and weight. The DEXA scan is typically used to diagnose disease of the bone such as osteopenia and osteoporosis and to follow efficacy of treatment for these conditions.
**Clinicians should evaluate the DXA "Z-scores" as opposed to the "T-scores" to accurately assess bone density in premenopausal women.
3. Pelvic Ultrasound: An ultrasound of your uterus, ovaries and fallopian tubes is often ordered, unless you have had a recent study which can be reviewed.
Abdominal and transvaginal ultrasound imaging may be helpful to rule out causes of pelvic pain and/or irregular or absent periods, such as: ovarian or pelvic tumors, ovarian torsion, hemorrhagic cysts and genital tract anomalies in adolescent. Appendicitis and/or other conditions in the gallbladder or intestines may also be identified.
Oftentimes a Follicular Ultrasound Series is warranted if there is a reason to suspect an ovulation disorder. This is a special imaging study which is done only by NaPro providers.
There are six Ovulation Disorders that NaPro providers look for:
1. MF = Mature Follicle (lacking an egg or with a retained egg)
2. LUF = Luteinized unruptured follicle
3. IFS = Immature follicle syndrome
4. PRS = Partial ruptured syndrome
5. DRS = Delayed rupture syndrome
6. AF = Afollicularism
Some women may have additional underlying problems such as: endometriosis, pelvic adhesions (scar tissue), blocked fallopian tubes, etc. which would warrant additional tests by a NaPro surgeon.
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