Overview of investigations for causes of amenorrhoea

Initial investigations for amenorrhoea (primary or secondary) or oligomenorrhoea include:

  • pregnancy test (if appropriate)
  • serum follicle stimulating hormone (FSH) and luteinising hormone (LH) concentrations
  • serum estradiol concentration
  • serum thyroid stimulating hormone (TSH) and prolactin concentrations
  • imaging such as a pelvic ultrasound to assess the structure of the vagina, uterus and ovaries1.

Subsequent investigations and need for specialist referral depend on whether amenorrhoea is primary or secondary, as well as the results of blood tests (especially FSH and estradiol concentrations), and whether a uterus and ovaries are present on ultrasound. See Investigations to determine the cause of primary amenorrhoea for investigation of primary amenorrhoea, and Investigations to determine the cause of secondary amenorrhoea for investigation of secondary amenorrhoea.

1 A transvaginal scan gives best detail, but a transabdominal scan is an alternative if a transvaginal ultrasound is not available or is declined. Pelvic magnetic resonance imaging (MRI) may be done after referral in primary amenorrhoea, but is not commonly required in secondary amenorrhoea.Return