Comprehensive Guide to Primary Amenorrhea Workup: History, Physical Examination, and Laboratory Tests

What is the initial work up of a patient with primary amenorrhea?

Breast and pelvic exam, pregnancy test, pelvic ultrasound and serum follicle-stimulating hormone

Primary amenorrhea is the lack of onset of menstrual cycles by the age of 16 years, or by the age of 14 years if secondary sexual characteristics have not developed. The initial workup of a patient with primary amenorrhea involves a thorough history, physical examination, and laboratory tests to determine the cause of this condition. The following are the steps involved in the workup of a patient with primary amenorrhea:

1. History: A detailed history should be taken to review the patient’s past medical and surgical history. The physician should inquire about family history, the presence of secondary sexual characteristics, and history of medications and illicit drug use.

2. Physical examination: A thorough physical examination should be performed to evaluate the patient’s height, weight, and body mass index (BMI). The physician should evaluate the patient’s Tanner staging for breast and pubic hair development, assess the presence of abdominal masses or pelvic abnormalities.

3. Laboratory tests: Appropriate laboratory tests should be ordered to determine the underlying cause of primary amenorrhea. These include:

– Pregnancy test: A urine or serum pregnancy test should be performed to rule out pregnancy.
– Thyroid function tests: Thyroid-stimulating hormone (TSH) and free thyroxine (T4) levels should be measured to assess thyroid function.
– Prolactin level: Elevated prolactin levels can cause amenorrhea and should be measured.
– Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels: These hormones play an important role in menstrual cycle regulation and should be measured.
– Karyotype: Karyotype analysis should be done to evaluate for chromosomal abnormalities, such as Turner syndrome.
– Pelvic ultrasound: Pelvic ultrasound should be done to evaluate for structural abnormalities of the reproductive organs.

Additional testing, such as MRI or CT scans may be recommended based on the results of the initial tests and physical examination.

Overall, the initial workup of a patient with primary amenorrhea is a comprehensive evaluation that requires a detailed history, physical examination, and laboratory testing to identify the underlying cause of the condition.

More Answers: