Get this App offline and editable on your phone

iPhone & iPad | Android | PC | Mac

Amenorrhea

  • Common ddx

    • pregnancy, lactation, menopause, athelete, PCOS, Turner's
  • Serious ddx

    • pituitary issue, ovarian cancer, ectopic pregnancy
  • Labs

    • hCG if suspect pregnancy or ectopic
    • FSH, LH, GnRH
    • TSH
    • progestin challenge (r/o obstruction if bleeds)
    • estrogen -> progestin challenge (Asherman's if no bleeding)
    • ultrasound if suspect obstruction
    • karyotype if abnormal anatomy or Turner's
    • testosterone, DHEA-S if suspect excess
  • Normal ddx

    • pregnancy, lactation, menopause
  • Ovarian failure (high FSH, LH)

    • menopause, premature ovarian failure, Turner syndrome
  • Hypothalamus failure (low FSH, LH, GnRH)

    • functional amenorrhea, Kallman syndrome
  • Pituitary failure (low FSH, LH, high GnRH)

    • craniopharyngioma, Sheehan syndrome
  • Hyperprolactinemia

    • prolactinoma, antipsychotics, antidepressants
  • Hypothyroidism

  • Testosterone excess

    • PCOS, Cushing, CAH, tumor
  • Genetic ddx

    • Y chromosome, androgen insensitivity
  • Anatomic obstruction

    • outflow obstruction, cervical stenosis, imperforate hymen, transverse vaginal septum
  • Other ddx

    • Asherman syndrome
  • HPI

    • primary vs secondary
    • primary amenorrhea is 14 yo, no menarche, no secondary sexual characteristics. Or, 16 yo, no menarche, has secondary sexual characteristics
    • secondary amenorrhea: previous menses that stopped for 6 mo (or 3 cycles)
    • onset, LMP, triggering events
    • associated pain, vaginal bleeding/spotting
  • ROS

    • lactation, galactorrhea
    • headache, visual changes, anosmia
    • activity level, atheletics
    • heat/cold intolerance
    • mood changes, hot flashes
    • abdominal pain or fullness
  • PMH, PSH, PGynH

    • past D&C
  • FH

  • SH

  • Meds

  • Allergies

  • Px

    • vitals
    • body habitus (obese or skinny), short stature
    • hirsutism
    • nipple discharge
    • axillary, pubic hair
    • ascites
    • pelvic exam
  • Tx

    • pulsatile GnRH if hypothalamic issue
    • bromocriptine, cabergoline if hyperprolactinemia
    • for PCOS: OCPs, weight loss, metformin
    • gonadectomy if male genotype with androgen insensitivity

  • Print | Citations

    Disclaimer: MDHero Workups is for educational use only, and is not meant to replace the clinical judgement of a professional. We do not guarantee the accuracy of any information on this website.