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



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