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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.

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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.

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