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* Secondary amenorrhea
  docholiday - 07/25/09 08:48
  What is the first test ordered in a 30 year old woman with a negative HCG that is complaining of amenorrhea for the past 6 months? She has no other complaints. BP 130/80, HR 85, BMI 31.5.  
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* Re:Secondary amenorrhea
  irp - 07/25/09 08:54
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* Re:Secondary amenorrhea
  cony - 07/25/09 09:19
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* Re:Secondary amenorrhea
  maddymami - 07/25/09 09:30
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* Re:Secondary amenorrhea
  docholiday - 07/25/09 09:52
  This question is from UW. Their 'correct' answer is progesterone stimulation test.

This does not adhere to guidelines.

It should be: TSH => prolactin => PCT => EPCT

I do not understand why they would choose progesterone. They even display a very nice (albeit) incorrect flow chart explaining the answer.

Perhaps they are thinking since the patient is obese and does not have any symptoms of thyroid dysfunction, then the problem is annovulatory cycles.
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* Re:Secondary amenorrhea
  drminga - 07/25/09 11:57
  yes, you can either do TSH/prolactin or do progesterone first.

when you do progesterone stimulation test 1st, if it is positive (pt has bleeding), then it is progesterone problem. if it is negative, then you would search for the reasons that cause amenohrrea. the most common reasons are elevated TSH (hypothyroidism) and hyperprolactinemia. then you should order TSH and serum prolactin.
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* Re:Secondary amenorrhea
  docholiday - 07/25/09 13:46
  Thanks dr  
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* Re:Secondary amenorrhea
  zainsyed - 08/15/12 10:22
  pregnancy test is definately the first step of managment this is followed by PCT.if PCT is positive(i.e. withdrawal bleeding is present) then the cause is low progesterone for which the most common cause is anovulation.anovulation can be due to high prolactin low thyroid hormones or could be idiopathic so then prolactin and tsh levels can be checked.however if PCT is negative then we move to EPCT. a positive EPCT would mean estrogen defiency while a negative EPCT would mean an outflow obstruction like asherman syndrome.a hysterosalpingogram can be ordered to identify the lesion.  
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* Re:Secondary amenorrhea
  sadhan - 08/15/12 15:15
  There is no guideline like start with TSH , then prolactin, and then do others.
. All of them TSH, prolactin are done first once HCG is negative. If these are normal, progesterone test for anovulation issues
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