- If present, indicates unresponsive endometrium.
- Suggested by the presence of cyclic events (e.g., mittelschmerz, premenstrual complaints).
- Diagnosed by basal body temperature charts, progesterone level, or endometrial biopsy.
- Estrogenic status
- Hypoestrogenic states are associated with osteoporosis regardless of cause.
- Suggested by hot flushes and vaginal dryness.
- Lack of Provera withdrawal suggests hypoestrogenic state but 10% to 15% of hypoestrogenic females will have some bleeding.
- Estradiol is useful only when the estradiol level is high (estrogen tumor).
- Vaginal cytology is helpful.
- Androgen excess
- Suggested by oily skin or hair, hirsutism, clitoromegaly, and defeminization
- Testosterone (50% ovarian, 50% adrenal), androstenedione (50% ovarian, 50% adrenal), dehydroepiandrosterone (DHEAS) (90% adrenal)
- 17-hydroxyprogesterone levels as necessary
- Pituitary status
- Suggested by galactorrhea, visual field defects.
FSH, LH, TSH, and prolactin: necessary for evaluation.
- Most patients require blood for FSH, LH, TSH, and prolactin.
- A progesterone withdrawal confirms outflow tract integrity and suggests normal endogenous estrogen.
- Absence of bleeding to even sequential estrogen and progester’ one necessitates a hysteroscopy or hysterosalpingogram.
- Testosterone and DHEAS levels are useful when androgenic features are present.
- GnRH stimulation test will be diagnostic for pituitary failure.
- CT scans and MRI are necessary with hyperprolactinemia.
Counseling is imperative with eating or weight disorders.