Secondary Amenorrhea

Diagnose cause of Secondary Amenorrhea: (Dx structural: US & saline-infusion sonohysterogram)

  • Most common causes of secondary amenorrhea: pregnancy, structural abnormalities, PCOS
  • Steps to determine cause of secondary amenorrhea:
    • Rule out pregnancy: Order beta-hCG.
    • Order labs: Prolactin, TSH, FSH, LH, Estradiol
      • Abnormal Prolactin or TSH levels: NONovarian cause!
      • Elevation of FSH and LH with low Estradiol: Primary ovarian insufficiency
        • If normal labs:
          • Progesterone Challenge Test (oral medroxyprogesterone acetate – 10mg X 7-10 days)
            • Pt bleeds within 1 week of completing: Rules out estrogen deficiency (Patient HAS estrogen.)
              • Consider PCOS.
            • If NO bleeding: Patient has low estrogen.
              • Hypogonadotropic hypogonadism
                • Order pituitary MRI – rule out intracranial causes (hypothalamic amenorrhea).


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