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Secondary Amenorrhea Testing
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INDICATIONS FOR TESTING
Amenorrhea with negative pregnancy test
ORDER
Prolactin
Luteinizing Hormone and Follicle Stimulating Hormone
Thyroid Stimulating Hormone
Normal prolactin
high LH
normal or low FSH
normal TSH
hirsutism, virilization, acne
Normal prolactin
low or normal LH/FSH
normal TSH
no hirsutism
ORDER
Estradiol, Adult
Premenopausal
Female, Serum or
Plasma
CONSIDER
Eating
disorder
Normal
estradiol
Low
estradiol
Pituitary or
hypothalamic
abnormality
High
CONSIDER
Fragile X syndrome
Fragile X (FMR1)
with Reflex to
Methylation Analysis
© 2006 ARUP Laboratories. All rights reserved. Revised 03/27/2014
Elevated
DHEA-S
Moderate
Rule out tumor
Pelvic
ultrasound
Abdominal CT
Hypothalamic
dysfunction
Normal
prolactin
high LH/FSH
normal TSH
ORDER
Testosterone, Free and Total (Includes Sex
Hormone Binding Globulin), Females or Children
Dehydroepiandrosterone Sulfate, Serum
Elevated
free
testosterone
High
Ovarian
failure
Chromosome
analysis for X
chromosome
abnormalities
High prolactin
normal LH/FSH
normal TSH
May
represent
menopause
ORDER
Thyroid Stimulating
Hormone with Reflex to
Free Thyroxine
Normal
High
Medication history
Primary
hypothyroidism
Moderate
Rule out
adrenal tumor
Adrenal CT
Ovarian
hyperandrogenism
(PCOS)
Thyroid
disease
Abnormal TSH
Adrenal
hyperandrogenism
or PCOS
Negative
Positive
CT/MRI
sella turcica
Discontinue
medication if
possible
Prolactinoma
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