Evaluation of primary amenorrhea

hCG: human chorionic gonadotropin; FSH: follicle-stimulating hormone; TSH: thyroid-stimulating hormone; PRL: prolactin; T: testosterone; DHT: dihydrotestosterone; LH: luteinizing hormone; GnRH: gonadotropin-releasing hormone; MRI: magnetic resonance imaging; PCOS: polycystic ovary syndrome.
* In addition to primary amenorrhea: hypertension (which can be severe), absence of secondary sexual characteristics, or minimal body hair. Refer to UpToDate topics on uncommon congenital adrenal hyperplasias.
¶ Refer to UpToDate topics on the evaluation of secondary amenorrhea for discussion of hyperprolactinemia, thyroid disease, and PCOS.
Δ Pituitary MRI not required in those with clear explanation for their hypogonadotropic amenorrhea, eg, celiac disease or type 1 diabetes mellitus. Refer to UpToDate topics on the evaluation and management of secondary amenorrhea.