Evaluation of primary amenorrhea: Uterus present

hCG: human chorionic gonadotropin; FSH: follicle-stimulating hormone; TSH: thyroid-stimulating hormone; PRL: prolactin; T: testosterone; POI: primary ovarian insufficiency; PCOS: polycystic ovary syndrome; GnRH: gonadotropin-releasing hormone; MRI: magnetic resonance imaging.
* Primary amenorrhea is defined as lack of menses by age 13 and no breast development, or lack of menses by age 15 and breast development is present.
¶ Refer to UpToDate topics on the evaluation of secondary amenorrhea for discussion of hyperprolactinemia, thyroid disease, and PCOS. These patients usually present with secondary rather than primary amenorrhea.
Δ Pituitary MRI not required in those with clear explanation for their hypogonadotropic amenorrhea, eg, celiac disease or type 1 diabetes mellitus.