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Secondary Amenorrhea
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β-hCG → prolactin/TSH/FSH/testosterone.
Decision
Outcome
Decision
Secondary amenorrhea (no menses ≥3 months with prior regular). First test?
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β-hCG
Decision
β-hCG result?
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Positive → pregnant
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Negative → check TSH, prolactin, FSH, testosterone
Outcome
Pregnancy — obstetric care
Decision
Pattern?
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↑ Prolactin (normal TSH) → pituitary adenoma; MRI
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↑ FSH → primary ovarian insufficiency
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↑ Testosterone → PCOS or androgen-secreting tumor
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↑ TSH → hypothyroidism
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All normal + prior uterine procedure → Asherman syndrome
Outcome
Prolactinoma — dopamine agonist
Outcome
Estrogen replacement; counsel about fertility
Outcome
PCOS — weight loss, OCPs, metformin, spironolactone; fertility: clomiphene or letrozole
Rotterdam criteria: ≥2 of oligo/anovulation, hyperandrogenism, polycystic ovaries on US.
Outcome
Levothyroxine
Outcome
Hysteroscopic adhesiolysis
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