Approach to Amenorrhea

Question 1

what is secondary amenorrhea?

Answer 1

the absence of a menstrual cycle in a normally menstruating female

Question 1

what is primary amenorrhea?

Answer 1

never having menarche

Question 2

what are some ddx for primary amenorrhea?

Answer 2

• endocrine: hypothyroidism/hyperthyroidism, pituitary adenoma (increased prolactin levels)
• functional hypothalamic amenorrhea (energy deficient; female athlete triad)
• constitutional delay - delayed puberty
• outflow tract obstruction: imperforate hymen
• primary ovarian insufficiency – genetics: Tuner

Question 3

what are some ddx for secondary amenorrhea?

Answer 3

• pregnancy
• thyroid issues
• prolactin issues ➔ pituitary adenoma
• menopause or primary ovarian insufficiency (genetics) or premature ovarian insufficiency
• functional hypothalamic amenorrhea
• brain neoplasm
• PCOS
• adrenal issues - congenital adrenal hyperplasia
• other iatrogenic causes - procedures or surgeries or adhesions

Question 4

what ix options do you have for amenorrhea?

Answer 4

hormones
- FSH and LH
- prolactin

thyroid
- TSH

adrenal
- DHEA, testosterone, 17-hydroxyprogesterone

pregnancy - b-hCG

karyotyping

head MRI - re: neuro neoplasms

pelvic u/s