Secondary Amenorrhea tree

Question 1

What is Secondary Amenorrhea?

Answer 1

Patient with prior menses has absent menses for longer than 6 months

Question 2

With secondary amenorrhea, what is the first thing you should do?

Answer 2

Check TSH and Prolactin levels

Question 3

With secondary amenorrhea, what is the first thing that you should do?

Answer 3

Check TSH and Prolactin levels

Question 4

If BOTH TSH and Prolactin are normal, what test should be performed next?

Answer 4

Progestogen test

Question 5

What is a (+) progestogen test result?

Answer 5

Withdrawal bleed

Question 6

If BOTH TSH and Prolactin are normal and there is a (+) progestogen test, what is the diagnosis?

Answer 6

Normogonadotropic hypogonadism

Question 7

What is a possible cause of Normogonadotropic Hypogonadism?

Answer 7

PCOS

Question 8

What is a (-) progestogen test result?

Answer 8

NO withdrawal bleed

Question 9

If there is no withdrawal bleed with the progestogen test, what is performed next?

Answer 9

Estrogen/Progestogen test

Question 10

If you have to perform the Estrogen/Progestogen test and there is a withdrawal bleed (+), what should you do?

Answer 10

Check FSH and LH levels

Question 11

If you have to perform the Estrogen/Progestogen test and there is NO withdrawal bleed (-), what is the likely diagnosis for the secondary amenorrhea?

Answer 11

Outflow obstruction

Question 12

If you check the TSH and Prolactin levels and the TSH comes back abnormal, what is causing the secondary amenorrhea?

Answer 12

Thyroid disease

Question 13

If you check the TSH and Prolactin and the prolactin comes back abnormal, what level will make you consider a tumor?

Answer 13

> 100

Question 14

What are 2 types of Prolactinomas in the brain?

Answer 14

Microadenoma

Macroadenoma

Question 15

What is a likely symptom of a Prolactinoma that may be causing secondary amenorrhea?

Answer 15

Galactorrhea

– nipple discharge