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Evaluation of amenorrhea
R B Kiningham1, B S Apgar, T L Schwenk
1University of Michigan Medical School, Chelsea, USA.
American Family Physician
|March 1, 1996
Summary
Before diagnosing amenorrhea, rule out pregnancy. Initial evaluation includes history, physical exam, and blood tests for thyroid-stimulating hormone (TSH) and prolactin, guiding further investigation for pituitary or hypothalamic dysfunction.
Area of Science:
- Reproductive Endocrinology
- Gynecology
Background:
- Amenorrhea, the absence of menstruation, necessitates a systematic diagnostic approach.
- Pregnancy is the most frequent cause and must be excluded first.
Purpose of the Study:
- To outline a diagnostic strategy for evaluating amenorrhea in non-pregnant women.
- To differentiate causes including endocrinopathies, pituitary tumors, and hypothalamic dysfunction.
Main Methods:
- Initial assessment involves detailed history and physical examination.
- Laboratory tests include serum prolactin and thyroid-stimulating hormone (TSH).
- Progesterone challenge test and hormonal assays (gonadotropins, FSH, LH) are used based on initial findings.
Main Results:
- Elevated prolactin or galactorrhea warrants pituitary imaging.
- A negative progesterone challenge test suggests hypoestrogenic amenorrhea.
- Further hormonal evaluation distinguishes ovarian failure from central causes of amenorrhea.
Conclusions:
- A stepwise diagnostic process is essential for accurate amenorrhea evaluation.
- Management strategies vary, including hormonal therapy and calcium supplementation for hypoestrogenic amenorrhea.