Evaluation and Management of Secondary Amenorrhea

Diagnostic Approach

• Consider pituitary imaging to rule out prolactinoma in patients with elevated prolactin levels, as recommended by the American Academy of Neurology 1
• Evaluate for polycystic ovary syndrome (PCOS) by measuring androgens (testosterone, androstenedione) and considering pelvic ultrasonography to assess for polycystic ovaries or structural abnormalities 1

Diagnostic Algorithm

• If prolactin levels are elevated, consider hyperprolactinemia as the cause of amenorrhea and evaluate for medications that can increase prolactin levels, as well as pituitary imaging to rule out prolactinoma 1
• If FSH and LH levels are low/normal, suggest hypothalamic amenorrhea or PCOS and evaluate for stress, excessive exercise, or disordered eating, as well as signs of hyperandrogenism 1