Secondary Amenorrhea Testing
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INDICATIONS FOR TESTING
Amenorrhea with negative pregnancy test
ORDER
Prolactin Thyroid
Abnormal TSH
Luteinizing Hormone and Follicle Stimulating Hormone disease
Thyroid Stimulating Hormone
Normal prolactin Normal prolactin High prolactin
High LH Normal prolactin
Low or normal LH/FSH Normal LH/FSH
Normal or low FSH High LH/FSH
Normal TSH Normal TSH
Normal TSH Normal TSH
No hirsutism
Hirsutism, virilization, acne
ORDER
May
CONSIDER ORDER ORDER Ovarian Thyroid Stimulating
represent
Eating Estradiol, Adult Testosterone, Free and Total (Includes Sex failure Hormone with Reflex to
menopause
disorder Premenopausal Female, Hormone Binding Globulin), Females or Children Free Thyroxine
Serum or Plasma Dehydroepiandrosterone Sulfate (DHEA-S), Serum
Normal High
Elevated Elevated Chromosome
free DHEA-S analysis for X
Normal Low testosterone chromosome
Primary
estradiol estradiol abnormalities Medication history
hypothyroidism
Pituitary or High Moderate High Moderate
hypothalamic
abnormality Negative Positive
Rule out tumor
Rule out
Pelvic
adrenal tumor Discontinue
ultrasound CT/MRI
Adrenal CT medication if
Abdominal CT sella turcica
possible
Hypothalamic CONSIDER
dysfunction Fragile X syndrome
Ovarian Adrenal
hyperandrogenism hyperandrogenism
Fragile X (FMR1) Prolactinoma
(PCOS) or PCOS
with Reflex to
Methylation Analysis
© 2006 ARUP Laboratories. All rights reserved. www.arupconsult.com Last updated: March 2020
