Causes of Secondary Amenorrhea - Differential Diagnosis Algorithm Absence of menses for more than 3 cycles or 6 months in women who were previously menstruating Ovarian - Normal FSH: • Polycystic ovarian syndrome (positive progesterone challenge, normal prolactin, chaotic menstruation history) Ovarian - High FSH: • Menopause • Premature ovarian failure (<35 years old, e.g. autoimmune, chromosomal, iatrogenic) Hypothalamic - Negative progesterone challenge, Low FSH, Low estrogen: • Functional (e.g. eating disorder, weight loss, stress, excessive exercise, illness) • Infiltrative lesions (e.g. lymphoma, Langerhans cell histiocytosis, sarcoidosis) Pituitary - High Prolactin: • Pituitary Adenoma • Prolactinoma • Chest wall irritation • Hypothalamic-Pituitary Stalk Damage (e.g. Tumors, trauma, compression) • Hypothyroidism Pituitary - Other: • Sheehan's Syndrome • Radiation • Infection • Infiltrative Lesions; hemochromatosis Outflow Tract Obstruction: • Asherman's syndrome • Cervical stenosis #Secondary #Amenorrhea #Differential #Diagnosis #Algorithm #Causes #OBGyn #Gynecology
