# Secondary Amenorrhea
-- LMP: ***
-- Previous Menses: *** cycle length, flow
-- Sexual Hx: *** currently having sex, partners, birth control use
-- Symptoms: *** weight change, hot flashes, galatorrhea, hirsutism, acne
-- Stressors: ***
-- Red Flags: ***
DDx: pregnancy, hypothalamic (malnutrition, stress, illness), pituitary (hyperprolactinemia from adenoma, breastfeeding, apoplexy), ovarian (primary insufficiency, PCOS), uterine (Asherman syndrome), thyroid, DM, Cushing’s
-- FSH, TSH, E2, prolactin, testosterone
-- If prolactin elevated on two checks or low/normal TSH and low E2, get pituitary MRI
-- If c/w menopause - no need to check labs
-- PCOS - weight loss, exercise, combined OCP, spironolactone, metformin if needed
-- Menopause - SSRI/SNRI (paroxetine) for hot flashes, hormonal therapy if <60 and lower risk for CVD, VTE, breast/endometrial cancer
Template PDF coming soon!
Workup for Secondary Amenorrhea
Based on the timing of your periods, you have secondary amenorrhea. To determine the cause of this change, we will perform a series of blood tests to check your hormone levels, including thyroid hormones, prolactin, and follicle-stimulating hormone (FSH), as imbalances in these can lead to amenorrhea. Depending on the results, we may also conduct imaging studies, such as an ultrasound to examine your reproductive organs for any structural abnormalities.
Once we have gathered some more information, we can regroup and determine the most appropriate next steps. If you have any questions, please don't hesitate to reach out.
Make sure the patient isn't pregnant. Send FSH, TSH, E2, prolactin, testosterone and follow a step-wise approach to eliminate etiologies based on the results of the labwork.