The first and foremost investigation that needs to be done is urine pregnancy test to exclude pregnancy. If the history and physical examination findings do not reveal the cause of the amenorrhea, a complete blood cell count, urinalysis, and serum chemistries should be evaluated to help rule out systemic disease. Serum prolactin, FSH, oestradiol, and thyrotropin levels should also be measured routinely in the initial evaluation of amenorrhoea once pregnancy has been excluded.
Another way of evaluating a patient with secondary amenorrhoea is by challenging the endometrium with progestin. A positive progestin challenge (i.e. presence of withdrawal bleeding after progestin administration) indicates functioning endometrium, thus ruling out the possibility of adhesions in the uterine cavity …show more content…
Serum oestradiol levels undergo wide fluctuations during the normal menstrual cycle. During the early follicular phase of the menstrual cycle, levels may be lower than 50 pg/mL. During the preovulatory oestradiol surge, levels in the range of 400 pg/mL are not uncommon. In healthy menopausal women, oestradiol levels are routinely lower than 20 pg/mL.
Obtaining the testosterone level is not necessary in a woman with no evidence of androgen excess.
Prolactin level in excess of 200 ng/mL is not observed except in the case of prolactin-secreting pituitary adenoma (prolactinoma). In general, the serum prolactin level correlates with the size of the tumor. Patients who are noted to have hyperprolactinaemia will require skull x-ray and MRI of the brain.
Polycystic ovaries may be seen on the ultrasound scan of patients with PCOS. However, only 40% of PCOS patients have this feature. The finding of polycystic ovaries, together with either anovulation of hyperandrogenism confirms PCOS.
Figure 10.1 shows the algorithm in the evaluation of a patient presented with secondary
Another way of evaluating a patient with secondary amenorrhoea is by challenging the endometrium with progestin. A positive progestin challenge (i.e. presence of withdrawal bleeding after progestin administration) indicates functioning endometrium, thus ruling out the possibility of adhesions in the uterine cavity …show more content…
Serum oestradiol levels undergo wide fluctuations during the normal menstrual cycle. During the early follicular phase of the menstrual cycle, levels may be lower than 50 pg/mL. During the preovulatory oestradiol surge, levels in the range of 400 pg/mL are not uncommon. In healthy menopausal women, oestradiol levels are routinely lower than 20 pg/mL.
Obtaining the testosterone level is not necessary in a woman with no evidence of androgen excess.
Prolactin level in excess of 200 ng/mL is not observed except in the case of prolactin-secreting pituitary adenoma (prolactinoma). In general, the serum prolactin level correlates with the size of the tumor. Patients who are noted to have hyperprolactinaemia will require skull x-ray and MRI of the brain.
Polycystic ovaries may be seen on the ultrasound scan of patients with PCOS. However, only 40% of PCOS patients have this feature. The finding of polycystic ovaries, together with either anovulation of hyperandrogenism confirms PCOS.
Figure 10.1 shows the algorithm in the evaluation of a patient presented with secondary