Evaluation of Amenorrhea

Secondary Sexual of Characteristic

Absent

Present

Physical Exam
Normal
FSH LEVEL

HCG (-)
Primary

Absent Uterus

HCG (+)

NO

5a reductase
deficiency
17-20 desmolase
defeciency
17 a-hydroxylase
defeciency (all with
XY karyotype)

High

Pregnancy

YES

Secondary (if Risk

of Endometrial
Scarring advise HSG
& Cultures to R/O
Ashermans,
Cervical Stenosis
and Infection

Normal

Physical Exam

Normal

Abnormal

TSH, PRL,FSH clinical

evaluation of estrogen
status

Normal TSH

Karyotype

Kallmans Syndrome
Physiologic Delay
Disorders of Low
estrogen status which
occur before puberty

XX
Y Line
Turners (XO)

Abnormal TSH

Normal PRL

High PRL
Hyperprolactinemia

Normal FSH

Normal Estrogen

Ovarian
Neoplasm
Granulosa
cell
androgensecreting

Low Estrogen

Feedback disorders
Obesity
Cushings syndrome
Androgen secreting
adrenal tumors
Congenital Adrenal
Hyperplasia

Chronic Disease :
Pulmonary, Renal,
Liver, Diabetes
Addisons Disease

Hyperthyroid
Hypothyroid

High FSH

Neurological Exam,
CT/MRI, EEG
Chronic
Anovulation
PCO
Idiophatic

Mullerian Anomally
Androgen Insensitivity
True Hermaphorodite

Normal

Hypothalamic Dysfunction
Anorexia
Exercise-induced
Stress
Pseudocyesis
Malnutrition

Ovarian Failure due to :

Chromosomal, Radiation,
Chemotherapy, Infections,
Autoimmune
Galactosemia
Savage Syndrome
Idiophatic

Abnormal

Pituatary-Hypothalamic
Lessions : Tumor, Infection,
Indarction, Pituitary Failure
Sheehans Syndrome
Toxic Lead
Diabetes Vasculitis