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Secondary Amenorrhea Testing

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INDICATIONS FOR TESTING


Amenorrhea with negative pregnancy test

ORDER
Prolactin
Luteinizing Hormone and Follicle Stimulating Hormone
Thyroid Stimulating Hormone

Normal prolactin
high LH
normal or low FSH
normal TSH
hirsutism, virilization, acne

Normal prolactin
low or normal LH/FSH
normal TSH
no hirsutism

ORDER
Estradiol, Adult
Premenopausal
Female, Serum or
Plasma

CONSIDER
Eating
disorder

Normal
estradiol

Low
estradiol

Pituitary or
hypothalamic
abnormality

High

CONSIDER
Fragile X syndrome
Fragile X (FMR1)
with Reflex to
Methylation Analysis

2006 ARUP Laboratories. All rights reserved. Revised 03/27/2014

Elevated
DHEA-S

Moderate

Rule out tumor


Pelvic
ultrasound
Abdominal CT
Hypothalamic
dysfunction

Normal
prolactin
high LH/FSH
normal TSH

ORDER
Testosterone, Free and Total (Includes Sex
Hormone Binding Globulin), Females or Children
Dehydroepiandrosterone Sulfate, Serum

Elevated
free
testosterone

High

Ovarian
failure

Chromosome
analysis for X
chromosome
abnormalities

High prolactin
normal LH/FSH
normal TSH

May
represent
menopause

ORDER
Thyroid Stimulating
Hormone with Reflex to
Free Thyroxine

Normal

High

Medication history

Primary
hypothyroidism

Moderate

Rule out
adrenal tumor
Adrenal CT

Ovarian
hyperandrogenism
(PCOS)

Thyroid
disease

Abnormal TSH

Adrenal
hyperandrogenism
or PCOS

Negative

Positive

CT/MRI
sella turcica

Discontinue
medication if
possible

Prolactinoma

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