From the Guidelines
Laboratory tests for evaluating amenorrhea should begin with pregnancy testing, followed by measurements of follicle-stimulating hormone (FSH), luteinizing hormone (LH), prolactin, thyroid-stimulating hormone (TSH), and estradiol, as recommended by the most recent and highest quality study 1. The evaluation of amenorrhea requires a comprehensive approach to determine the underlying cause.
- The initial laboratory tests should include:
- Pregnancy testing to rule out pregnancy as a cause of amenorrhea
- FSH, LH, prolactin, TSH, and estradiol to assess the hypothalamic-pituitary-ovarian axis
- Additional testing may be necessary to evaluate for hyperandrogenism, such as:
- Testosterone and dehydroepiandrosterone sulfate (DHEAS) to assess for polycystic ovary syndrome or adrenal disorders
- If premature ovarian failure is suspected, karyotyping may be warranted 1.
- For patients with elevated prolactin, magnetic resonance imaging (MRI) of the pituitary gland should be considered to rule out prolactinoma 1.
- In cases where anatomical abnormalities are suspected, pelvic ultrasound can evaluate the uterus and ovaries 1.
- A progesterone challenge test may also be useful to assess estrogen status and endometrial function 1. It is essential to note that amenorrhea can result from dysfunction at multiple levels of the hypothalamic-pituitary-ovarian axis, and proper diagnosis guides appropriate treatment 1. The most recent study 1 provides a comprehensive approach to evaluating amenorrhea, and its recommendations should be followed to ensure accurate diagnosis and effective treatment. In clinical practice, it is crucial to prioritize the most recent and highest quality evidence, such as the study by 1, to guide decision-making and ensure the best possible outcomes for patients with amenorrhea.
From the Research
Laboratory Tests for Amenorrhea
The following laboratory tests are recommended for the evaluation of amenorrhea:
- Pregnancy test: to rule out pregnancy as a cause of amenorrhea 2, 3, 4
- Serum hormone levels:
- Progesterone challenge test to determine outflow tract patency and estrogen status 3
- Karyotyping to evaluate for chromosomal abnormalities in cases of primary amenorrhea 4
- Serum androgen evaluation to evaluate for hyperandrogenism 4
- Pelvic or brain imaging to evaluate for anatomical abnormalities or pituitary adenomas 3, 4
Special Considerations
- Patients with primary ovarian insufficiency may require hormone replacement therapy, contraception, or infertility services 2, 4
- Patients with functional hypothalamic amenorrhea may require evaluation for disordered eating and low bone density 2, 4
- Patients with polycystic ovary syndrome may require screening and intervention to attenuate metabolic disease and endometrial cancer risk 2, 4