Algorithm for Evaluation of Amenorrhea - Flowchart
Algorithm for Evaluation of Amenorrhea - Flowchart
«Flowchart»

AMENORRHEA/OLIGOMENORRHEA
Uterus and outflow tract

AMENORRHEA/OLIGOMENORRHEA
Uterus and outflow tract

AMENORRHEA/OLIGOMENORRHEA
Uterus and outflow tract

AMENORRHEA/OLIGOMENORRHEA

Normal

Normal

Normal

Abnormal

Abnormal

Abnormal

Pregnancy

Pregnancy

Pregnancy

Pregnancy

GYN referral

GYN referral

GYN referral

GYN referral

Normal PRL, FSH
Negative trial of estrogen/progesterone

Normal PRL, FSH
Negative trial of estrogen/progesterone

Normal PRL, FSH
Negative trial of estrogen/progesterone


R/O tumor
R/O 21 hydroxylase deficiency

R/O tumor
R/O 21 hydroxylase deficiency

R/O tumor
R/O 21 hydroxylase deficiency


Asherman's syndrome

Asherman's syndrome

Asherman's syndrome

Polycystic ovarian syndrome

Polycystic ovarian syndrome

Polycystic ovarian syndrome

Polycystic ovarian syndrome

Ovarian insufficiency

Ovarian insufficiency

Ovarian insufficiency

Ovarian insufficiency

GYN referral

GYN referral

GYN referral

GYN referral

R/O drugs, TSH

R/O drugs, TSH

R/O drugs, TSH

MRI

MRI

MRI

R/O discuss diet, exercise, stress

R/O discuss diet, exercise, stress

R/O discuss diet, exercise, stress

Neuroanatomic abnormality or idiopathic hypogonadotropic hypogonadism

Neuroanatomic abnormality or idiopathic hypogonadotropic hypogonadism

Neuroanatomic abnormality or idiopathic hypogonadotropic hypogonadism

Neuroanatomic abnormality or idiopathic hypogonadotropic hypogonadism

Hypothalamic amenorrhea

Hypothalamic amenorrhea

Hypothalamic amenorrhea

Hypothalamic amenorrhea

End

End

End

Androgen insensitivity syndrome

Androgen insensitivity syndrome

Androgen

Müllerian agenesis, cervical stenosis, vaginal septum, imperforate hymen

Müllerian agenesis, cervical stenosis, vaginal septum, imperforate hymen

Müllerian

Uterine instrumentation

Uterine instrumentation

Uterine

Normal or low

Normal or low

Normal or low

Increased (x2)

Increased (x2)

Increased (x2)

PRL

PRL

PRL

Increased

Increased

Increased

Normal

Normal

Normal

1° amenorrhea, short stature or clinical suspicion

1° amenorrhea, short stature or clinical suspicion

1° amenorrhea,

2° amenorrhea

2° amenorrhea

2° amenorrhea

ß-hCG

ß-hCG

ß-hCG

+

-

Hyperandrogenism testosterone, hirsutism, acne

Hyperandrogenism testosterone, hirsutism, acne

Hyperandrogenism

FSH

FSH

FSH