From the Guidelines
A laboratory workup for irregular menses should include a comprehensive panel of tests, prioritizing those that identify potential underlying causes of morbidity and mortality, such as polycystic ovary syndrome (PCOS), thyroid disorders, and hyperprolactinemia, as recommended by the most recent study 1. When evaluating irregular menses, it is essential to consider the potential underlying causes and their impact on morbidity, mortality, and quality of life. The most recent study 1 highlights the importance of identifying PCOS, a common endocrine disorder that affects young women and is characterized by ovulatory dysfunction, hyperandrogenism, infertility, and insulin resistance.
Initial Laboratory Tests
The initial laboratory tests should include:
- Complete blood count
- Thyroid function tests (TSH, free T4)
- Prolactin level
- Comprehensive metabolic panel to assess overall health status
- Reproductive hormone evaluation, including follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol, and testosterone levels
- Pregnancy test to rule out pregnancy as a cause
Additional Tests for PCOS
If PCOS is suspected, additional tests should be included, such as:
- Free testosterone
- DHEAS
- 17-hydroxyprogesterone
- Fasting glucose and insulin levels to assess insulin resistance
Timing of Tests
Timing these tests appropriately during the menstrual cycle (typically early follicular phase, days 2-5) is crucial for accurate hormone assessment, as noted in the study 1.
Additional Testing
Additional testing may be warranted based on initial results, including pelvic ultrasound to evaluate ovarian morphology and endometrial thickness, as recommended by the study 1. This comprehensive approach helps identify conditions that commonly cause menstrual irregularities and allows for early intervention to improve morbidity, mortality, and quality of life outcomes.
From the Research
Initial Evaluation
The initial evaluation of irregular menses includes:
- A thorough medical history
- A physical examination
- Laboratory tests to determine the underlying cause of menstrual irregularity 2, 3, 4
Laboratory Tests
The laboratory tests that are typically included in the workup of irregular menses are:
- Pregnancy test
- Serum levels of luteinizing hormone
- Serum levels of follicle-stimulating hormone
- Serum levels of prolactin
- Serum levels of thyroid-stimulating hormone 2
Common Causes
The common causes of irregular menses include:
- Polycystic ovary syndrome
- Hypothalamic amenorrhea
- Hyperprolactinemia
- Primary ovarian insufficiency
- Anatomic abnormalities (e.g., Müllerian agenesis)
- Chromosomal irregularities (e.g., Turner syndrome) 2, 3
Special Considerations
Special considerations should be given to patients with certain conditions, such as:
- Primary ovarian insufficiency, who can maintain unpredictable ovarian function and should not be presumed infertile
- Hypothalamic amenorrhea, who should be evaluated for eating disorders and are at risk for decreased bone density
- Polycystic ovary syndrome, who are at risk for glucose intolerance, dyslipidemia, and other aspects of metabolic syndrome
- Turner syndrome (or variant), who should be treated by a physician familiar with the appropriate screening and treatment measures 2