AMENORRHEA/OLIGOMENORRHEA
Uterus and outflow tract

Normal

Abnormal

Pregnancy

GYN referral

Normal PRL, FSH
Negative trial of estrogen/progesterone

R/O tumor
R/O 21 hydroxylase deficiency

Asherman's syndrome

Polycystic ovarian syndrome

Ovarian insufficiency

GYN referral

R/O drugs, TSH

MRI

R/O eating disorder, chronic disease

Neuroanatomic abnormality or idiopathic hypogonadotropic hypogonadism

Hypothalamic amenorrhea

End

Androgen insensitivity syndrome

Müllerian agenesis, cervical stenosis, vaginal septum, imperforate hymen

Uterine instrumentation

Normal or low

Increased (x2)

PRL

Increased

Normal

1° amenorrhea, short stature or clinical suspicion

2° amenorrhea

Hyperandrogenism testosterone, hirsutism, acne

FSH

-hCG, beta-human chorionic gonadotropin; FSH, follicle-stimulating hormone; GYN, gynecologist; PRL, prolactin; R/O, rule out; TSH, thyroid-stimulating hormone.

-hCG

-hCG