WH EOR

2ry amenorrhea w/ previously regular menstrual cycles

3m

2ry amenorrhea w/ previously irregular menstrual cycles

6m

What level of PRL may suggest empty sella syndrome or a pituitary issue

>100

If bleed occurs after estrogen priming

Check FSH/LH—> primary ovarian failure or pituitary tumor, eating do, chronic illness

oligomenorrhea

Fewer than 9 menstrual cycles/ yr or >35 days

If positive protestin challenge

MC PCOS

What is the definition of primary amenorrhea if sexual development

No menses by age 15 w/ normal growth

Estrogen priming

Oral conjugated estrogen 0.625/d for 35d, medroxyprogesterone added days 26-35

If no bleed for estrogen priming?

Outflow tract obstruction

Secondary dysmenorrhea

Painful menstruation related to pelvic pathology Can occur any time in the menstrual cycle

PALM-COEIN

Polyps, Adenomyosis, Leiomyomas, Malignancy, Coagulation, Ovarian dysfxn, Endometriosis, Iatrogenic, Not yet classified

If no withdraw bleed with protestin challenge

Sx of hypoestrogenism or outflow tract disorder —> estrogen priming

What labs do you order in primary amenorrhea?

hCG, FSH, TSH, PRL

If uterus is absent in primary amenorrhea, what do you order?

karyotype and serum T

primary dysmenorrhea

painful menstruation that begins at puberty and has no clear cause