I have not getting period also complete primulate N tablets course

Professional Clinical Assessment: Primary differential diagnoses include perimenopause, pregnancy, hypothalamic amenorrhea, polycystic ovary syndrome (PCOS), and potential medication-related amenorrhea, particularly considering the patient's age of 40 and reported Primolut N usage. The pathophysiological mechanisms likely involve hormonal imbalances affecting the hypothalamic-pituitary-ovarian axis, with potential disruption of normal menstrual cycling, especially given the age-related declining ovarian reserve and hormonal transitions typical in perimenopausal women. Age-specific risk factors at 40 include increasing likelihood of perimenopause onset, higher risk of thyroid dysfunction, and potential underlying gynecological conditions that become more prevalent in this age group. Recommended additional testing should include comprehensive hormone panel (FSH, LH, estradiol, progesterone), thyroid function tests, pregnancy test, and pelvic ultrasound to evaluate structural causes; urgent evaluation is warranted if severe pain, heavy bleeding, or signs of pregnancy are present.

For irregular/missing periods at age 40, I recommend starting on Cyclic Progesterone therapy (like Provera 10mg) for 10-12 days to induce withdrawal bleeding and regulate cycles. Additionally, supplement with Iron (65mg elemental iron daily) and Vitamin B12 (1000mcg daily) to support hormonal balance and address any potential deficiencies. Consider adding Black Cohosh (40mg twice daily) as a natural supplement to help regulate hormonal fluctuations that are common during perimenopause. For additional treatment recommendations, ask in the chat.