Assessment and Plan for Secondary Amenorrhea

-Algorithm for secondary amenorrhea reviewed (from AAFP).
-History & Physical performed.
-Reviewed all medications, including contraceptives and illicit drugs.
-Definition: The cessation of previously regular menses for 3 months or the cessation of previously irregular menses for six months.
-Pregnancy test (Beta-hCG in urine or serum). Serum LH, FSH, TSH, Prolactin, and Estradiol.
-CBC, CMP, and urinalysis to help r/o systemic disease.
-Pelvic U/S

 

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Hypothalamic Amenorrhea – This is ruled out by measuring LH, FSH, and Estradiol.

References
The AAFP has a great article from 2013, Amenorrhea: An Approach to Diagnosis and Management, Am Fam Physician. 2013;87(11):781-788

https://my.clevelandclinic.org/health/articles/amenorrhea

http://emedicine.medscape.com/article/252928-workup

# Primary Amenorrhea
Definition:

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