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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