An algorithm for women who have developed secondary sexual characteristics, have experienced menarche, and are presenting with amenorrhea or oligomenorrhea.

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Presentation transcript:

An algorithm for women who have developed secondary sexual characteristics, have experienced menarche, and are presenting with amenorrhea or oligomenorrhea. A negative human chorionic gonadotropin test documents the nonpregnant state. All women should be screened for known causes of oligomenorrhea, whether or not hyperandrogenism is present. Hyperandrogenism suggests either polycystic ovarian syndrome (PCOS) or late-onset congenital adrenal hyperplasia (CAH). If rapid in onset, progressive virilization requires an evaluation for an androgen-secreting tumor. Management of late-onset CAH and PCOS is similar. Clinical history and physical findings suggesting hypoestrogenism, stress, or thyroid dysfunction are indications for measurement of estradiol (E2), luteinizing hormone (LH), and free thyroid hormone (FT4) levels in plasma (APS, autoimmune polyglandular syndrome). *As indicated (refer to text). Source: Chapter 13. Female Reproductive Endocrinology and Infertility, Greenspan’s Basic & Clinical Endocrinology, 9e Citation: Gardner DG, Shoback D. Greenspan’s Basic & Clinical Endocrinology, 9e; 2011 Available at: https://accessmedicine.mhmedical.com/DownloadImage.aspx?image=/data/books/gard9/gard9_c013f009.gif&sec=39748093&BookID=380&ChapterSecID=39744053&imagename= Accessed: January 01, 2018 Copyright © 2018 McGraw-Hill Education. All rights reserved