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Secondary Amenorrhea Testing Algorithm

This document provides an algorithm for testing secondary amenorrhea with a negative pregnancy test. It outlines the following tests that should be ordered: prolactin, LH, FSH, and TSH. Based on the results of those initial tests, it provides guidance on additional tests that may be ordered, such as estradiol, testosterone, DHEA-S, thyroid stimulating hormone, fragile X testing, pelvic ultrasound, CT scans, and chromosome analysis. The goal is to determine if the cause is hyperprolactinemia, ovarian failure, hypothalamic or pituitary dysfunction, thyroid disease, adrenal dysfunction, polycystic ovary syndrome, or other conditions.

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367 views1 page

Secondary Amenorrhea Testing Algorithm

This document provides an algorithm for testing secondary amenorrhea with a negative pregnancy test. It outlines the following tests that should be ordered: prolactin, LH, FSH, and TSH. Based on the results of those initial tests, it provides guidance on additional tests that may be ordered, such as estradiol, testosterone, DHEA-S, thyroid stimulating hormone, fragile X testing, pelvic ultrasound, CT scans, and chromosome analysis. The goal is to determine if the cause is hyperprolactinemia, ovarian failure, hypothalamic or pituitary dysfunction, thyroid disease, adrenal dysfunction, polycystic ovary syndrome, or other conditions.

Uploaded by

polygone
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Secondary Amenorrhea Testing

Click here for topics associated with this algorithm

INDICATIONS FOR TESTING


Amenorrhea with negative pregnancy test

ORDER
Prolactin
Luteinizing Hormone and Follicle Stimulating Hormone
Thyroid Stimulating Hormone

Normal prolactin
high LH
normal or low FSH
normal TSH
hirsutism, virilization, acne

Normal prolactin
low or normal LH/FSH
normal TSH
no hirsutism

ORDER
Estradiol, Adult
Premenopausal
Female, Serum or
Plasma

CONSIDER
Eating
disorder

Normal
estradiol

Low
estradiol

Pituitary or
hypothalamic
abnormality

High

CONSIDER
Fragile X syndrome
Fragile X (FMR1)
with Reflex to
Methylation Analysis

2006 ARUP Laboratories. All rights reserved. Revised 03/27/2014

Elevated
DHEA-S

Moderate

Rule out tumor


Pelvic
ultrasound
Abdominal CT
Hypothalamic
dysfunction

Normal
prolactin
high LH/FSH
normal TSH

ORDER
Testosterone, Free and Total (Includes Sex
Hormone Binding Globulin), Females or Children
Dehydroepiandrosterone Sulfate, Serum

Elevated
free
testosterone

High

Ovarian
failure

Chromosome
analysis for X
chromosome
abnormalities

High prolactin
normal LH/FSH
normal TSH

May
represent
menopause

ORDER
Thyroid Stimulating
Hormone with Reflex to
Free Thyroxine

Normal

High

Medication history

Primary
hypothyroidism

Moderate

Rule out
adrenal tumor
Adrenal CT

Ovarian
hyperandrogenism
(PCOS)

Thyroid
disease

Abnormal TSH

Adrenal
hyperandrogenism
or PCOS

Negative

Positive

CT/MRI
sella turcica

Discontinue
medication if
possible

Prolactinoma

www.arupconsult.com

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