Secondary Amenorrhea Algorithm for workup Flashcards
(17 cards)
What it the best test if b-hcg is (-)?
TSH
If TSH is increased what do you do next?
Check free T4: treat hypothyroidism with Levothyroxine
If TSH is decreased what do you do next?
Treat hyperthyroidism with PTU or Methimazole
If TSH is normal what do you check next?
Prolactin
If prolactin is increased what do you do?
Review medications, MRI of head
Treat with Carergoline or bromocriptine
If Prolactin is Normal what do you check next?
FSH
If FSH is increased what do you do?
Primary ovarian insufficiency: Check for symptoms like hot flashes and vaginal dryness
If FSH is decreased or normal what do you do next?
Check Estradiol
If Estradiol is low what do you do?
Pituitary MRI
Suggestive of Hypogonadotropic Hypogonadism
If Estradiol is normal what do you do next?
testosterone or clinical hyperandrogenism?
If testosterone is elevated or there is clinical hyperandrogenism what do you do?
Diagnose PCOS
If Testosterone is normal and there is no clinical hyperandrogenism what do you do next?
Progesterone withdrawal test
What is a (+) Progesterone withdrawal test?
Withdrawal bleeding occurs
what does a (+) progesterone withdrawal test suggest?
Anovulation
if there is a (-) progesterone withdrawal test what do you do next?
Estrogen-progesterone challenge test
If there is no bleeding after estrogen-progesterone challenge test what do you do next?
Hysteroscopy or Hysterosalpingogram to evaluate outflow tract obstruction
If there is withdrawal bleeding after estrogen-progesterone challenge test what do you do next?
Estrogen deficiency: perform pituitary MRI for hypogonadotropic Hypogonadism
