Secondary amenorrhea. A protocol for pinpointing the underlying cause.
Secondary amenorrhea presents the primary care physician with a diagnostic challenge because of the many disorders that can cause it. Thus, its evaluation warrants a systematic approach to avoid unnecessary and expensive diagnostic procedures. By using the step-by-step protocol outlined in this article, the clinician can isolate the dysfunctional compartment--outflow tract, ovary, anterior pituitary, CNS, or hypothalamus--and then pursue a more specific workup to pinpoint the cause. Treatment depends on the patient's desire for pregnancy, and the need for long-term follow-up is dictated by the specific diagnosis.
Malo
J W
JW
Bezdicek
B J
BJ
D000328:Adult; D000367:Age Factors; D000568:Amenorrhea / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D000858:Anovulation / Q000188:drug therapy; D003276:Contraceptives, Oral / Q000627:therapeutic use; D004967:Estrogens / Q000378:metabolism / Q000627:therapeutic use; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D006062:Gonadotropins / Q000378:metabolism; D006801:Humans; D006966:Hyperprolactinemia / Q000150:complications / Q000175:diagnosis; D007621:Karyotyping; D008597:Menstrual Cycle; D011247:Pregnancy; D011258:Pregnancy Tests; D011372:Progestins / Q000627:therapeutic use; D012729:Sex Chromosome Aberrations / Q000150:complications / Q000175:diagnosis; D013961:Thyroid Gland / Q000503:physiopathology; D013997:Time Factors
D003276:Contraceptives, Oral; D004967:Estrogens; D006062:Gonadotropins; D011372:Progestins; D005640:Follicle Stimulating Hormone