Secondary Amenorrhea

What are the findings of menopause?

- Increased FSH/LH - Absent follicles on ultrasound - Low Estrogen

What is the algorithm for Secondary Amenorrhea workup?

1. Is it the common stuff? (UPT, TSH, Prolactin, Meds) 2. Is the endometrium ready to bleed? (Progestin Challenge) 3. Is the endometrium capable of bleeding? (Estrogen and Progesterone) 4. Is there a signal coming from the pituitary? (FSH and LH) 5a. Is there a problem with the anterior pituitary? (MRI) 5b. Are there follicles? (U/S) 6. All has been negative -Hypothalamus

What are initial tests to check for common causes of secondary amenorrhea?

1. UPT (pregnancy) 2. TSH (thyroid) 3. Prolactin (meds/prolactinoma)

What is the treatment of a prolactinoma?

Dopamine agonists (pramipexole, ropinerole)

What medications can cause secondary amenorrhea?

Medications that inhibit dopamine (e.g. Atypical antipsychotics)

What are causes of secondary amenorrhea?

Most common: 1. Pregnancy 2. Thyroid disease 3. Prolactinoma Less common: 4. Medications 5. Menopause 6. Savage syndrome 7. Asherman's syndrome 8. Hypothalamic (weight loss, stress)

What is savage syndrome?

Ovaries are resistant to FSH and therefore will not ovulate

What is Asherman's syndrome?

Scarring and fibrosis of the endometrium due to vigorous D/C Causes an inability of endometrium to proliferate properly