Abstract
Secondary amenorrhea presents the primary care physician with a diagnostic challenge because of the many disorders that can cause it. Thus, its evaluation warrants a systematic approach to avoid unnecessary and expensive diagnostic procedures. By using the step-by-step protocol outlined in this article, the clinician can isolate the dysfunctional compartment--outflow tract, ovary, anterior pituitary, CNS, or hypothalamus--and then pursue a more specific workup to pinpoint the cause. Treatment depends on the patient's desire for pregnancy, and the need for long-term follow-up is dictated by the specific diagnosis.
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