Pregnancy should be ruled out with a pregnancy test.

If the pregnancy test is negative and the patient is not taking hormonal contraception, then simple observation for a single missed period is the usually the wisest course. Delay of periods in operational settings is common. In Boot Camp, among women not on BCPs, about 1/3 of women will skip periods for up to three months. The same observation is found among college freshman women. Presumably, this is a stress response.

If the patient remains without a period for an extended length of time (3 months or more), then the following are often done:

• Normal menstrual flows are re-established with either BCPs, or Provera (10 mg a day x 5 days, followed 3 days later by a period). Provera works well if ovarian function is not deeply depressed, but will not work for some women. BCPs will usually work regardless of the degree of ovarian suppression.
• The patient is tested for thyroid malfunction. (TSH or Thyroid Stimulating Hormone test).
• The patient is tested for prolactin disorders. (prolactinoma, often associated with inappropriate milk secretion from the nipples)
• The patient is tested for premature ovarian failure. (FSH/follicle stimulating hormone and LH/luteinizing hormone)
• If any of these tests are abnormal or neither Provera nor BCPs are effective in restarting normal periods, gynecologic consultation upon return to garrison is indicated.