Causes of Primary and Secondary Amenorrhea - Differential Diagnosis Algorithm
Primary Amenorrhea - No onset of menarche by age 16 with secondary sexual characteristics OR No onset of menarche by age 14 without secondary sexual characteristics
• Ovarian Etiology - High FSH, Low Estrogen
• Receptor Abnormalities and Enzyme Deficiencies
• Congenital Outflow Tract Anomalies
• Central - Hypothalamic
• Central - Pituitary
Secondary Amenorrhea - Absence of menses for more than 3 cycles or 6 months in women who were previously menstruating
• Ovarian - Normal FSH
• Ovarian - High FSH
• Hypothalamic - Negative progesterone challenge, Low FSH, Low estrogen:
• Pituitary - High Prolactin
• Pituitary - Other
• Outflow Tract Obstruction
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