title: Evaluation of amenorrhea.
abstract: Pregnancy is the most common cause of amenorrhea and must be ruled out before proceeding with diagnostic evaluation. A careful history and physical examination may reveal evidence of androgen excess, estrogen deficiency or other endocrinopathies. Serum prolactin and thyroid-stimulating hormone (TSH) levels should be checked in all women who are not pregnant. Galactorrhea by history or on examination and/or an elevated prolactin level should be investigated with an imaging study to rule out a pituitary adenoma. If serum prolactin and TSH levels are normal, a progesterone challenge test should be performed to determine outflow tract patency and estrogen status. In women with hypoestrogenic amenorrhea, indicated by a negative challenge test and a competent outflow tract, serum gonadotropin, follicle-stimulating hormone and luteinizing hormone levels may be measured to determine whether amenorrhea represents ovarian failure or pituitary or hypothalamic dysfunction. Hypothalamic amenorrhea is common in women with a history of weight loss, stress or vigorous exercise. Amenorrheic women with adequate estrogen levels should receive cyclic progesterone. Hormonal therapy and calcium supplementation in hypoestrogenic amenorrhea.
authors.affiliation: University of Michigan Medical School, Chelsea, USA.
authors.forename: R B
authors.initials: RB
authors.lastname: Kiningham
authors.forename: B S
authors.initials: BS
authors.lastname: Apgar
authors.forename: T L
authors.initials: TL
authors.lastname: Schwenk
mesh_terms: D000328:Adult; D000568:Amenorrhea / Q000097:blood / Q000175:diagnosis*; D000858:Anovulation / Q000175:diagnosis; D004967:Estrogens / Q000097:blood; D005260:Female; D005640:Follicle Stimulating Hormone / Q000097:blood; D005831:Genital Diseases, Female / Q000097:blood; D006801:Humans; D007027:Hypothalamic Diseases / Q000097:blood; D007986:Luteinizing Hormone / Q000097:blood; D008597:Menstrual Cycle; D010808:Physical Examination; D010900:Pituitary Diseases / Q000097:blood; D011247:Pregnancy; D011258:Pregnancy Tests; D011388:Prolactin / Q000097:blood; D013972:Thyrotropin / Q000097:blood
chemical_list: D004967:Estrogens; D011388:Prolactin; D007986:Luteinizing Hormone; D005640:Follicle Stimulating Hormone; D013972:Thyrotropin