Evaluation of secondary amenorrhea

hCG: human chorionic gonadotropin; BMI: body mass index; FSH: follicle-stimulating hormone; E2: estradiol; TSH: thyroid-stimulating hormone; PRL: prolactin; T: testosterone; MRI: magnetic resonance imaging; PCOS: polycystic ovary syndrome.
* Many clinicians also measure serum 17-hydroxyprogesterone at the initial visit to rule out nonclassic 21-hydroxylase deficiency. Some also measure serum dehydroepiandrosterone sulfate (DHEAS).
¶ Mild hyperprolactinemia can sometimes be seen with hypothyroidism. Euthyroidism should be confirmed before performing MRI.
Δ Pituitary MRI not required in those with clear explanation for their hypogonadotropic amenorrhea, eg, eating disorder, excessive exercise, celiac disease, or type 1 diabetes mellitus.