Amenorrhea

End

Pregnancy, trophoblastic disease, or hCG-secreting tumor

Thyroid disease

Imaging of pituitary for prolactinoma

Measure PRL, TSH, and FT₄

PRL HIGH; TSH and FT₄ NORMAL

All NORMAL

PRL NORMAL or HIGH; TSH and FT₄ ABNORMAL

Primary ovarian failure

Evaluate endogenous estrogen status using progestin withdrawal test

Withdrawal bleeding absent

Withdrawal bleeding present

HIGH

LOW or NORMAL

Hypothalamic-pituitary disease

HIGH

HIGH

HIGH

Androgens

Testosterone

DHEAS

17-OH Progesterone

Evaluate for PCOS or ovarian tumor

Evaluate for adrenal tumor

Evaluate for adrenal hyperplasia

Measure hCG

>5 mIU/ml

<5 mIU/ml

Imaging of genital tract for outlet obstruction, congenital anomaly, or intrauterine adhesions

Measure FSH and LH