title: A schematic approach to the work-up of amenorrhea.
abstract: Amenorrhea is a symptom having many possible causes. Since amenorrhea can result from disturbed function anywhere in the hypothalamic-pituitary-ovarian-uterine axis, a specific etiologic diagnosis must be made if treatment is to be effective. For this purpose, a diagnostic scheme for the differential diagnosis of the etiology of primary and secondary amenorrhea  is proposed. This scheme includes a progestin test, a cyclic estrogen and progestin test, a luteinizing hormone-releasing hormone (LH-RH) loading test, and a gonadotropin (human menopausal gonadotropin and human chorionic gonadotropin) loading test. A specific pattern of responses to LH-RH and gonadotropins exists in patients with hypothalamic, pituitary, and ovarian amenorrheas, respectively, and the character of the response may facilitate the etiologic diagnosis of amenorrhea. The clinical usefulness and/or value of the scheme in the diagnosis and treatment of amenorrheas is discussed.
mesh_terms: D000328:Adult; D000568:Amenorrhea / Q000209:etiology*; D002715:Chlormadinone Acetate; D006063:Chorionic Gonadotropin; D003937:Diagnosis, Differential; D004700:Endocrine System Diseases / Q000150:complications / Q000175:diagnosis*; D004967:Estrogens / Q000652:urine; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D007987:Gonadotropin-Releasing Hormone; D006801:Humans; D007986:Luteinizing Hormone / Q000097:blood; D008596:Menotropins; D008656:Mestranol; D011374:Progesterone
chemical_list: D006063:Chorionic Gonadotropin; D004967:Estrogens; D002715:Chlormadinone Acetate; D007987:Gonadotropin-Releasing Hormone; D011374:Progesterone; D008596:Menotropins; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; D008656:Mestranol