Primary Amenorrhea Algorithm

Question 1

Overview

Answer 1

• Presence of uterus
• Outflow tract
• Breast development
• FSH level

Question 2

• Uterus: absent
• Karyotype: XY, 46

Answer 2

Androgen Insensitivity Syndrome

Question 3

• Uterus: absent
• Karyotype: XX, 46

Answer 3

Mullerian Agenesis

Question 4

• Uterus: present
• Outflow tract: obstructed

Answer 4

Imperforate Hymen
Transverse Vaginal Septum
Vaginal Agenesis

Question 5

• Uterus: present
• Outflow tract: patent
• Breast: undeveloped
• FSH: > 30

Answer 5

Gonadal Dysgenesis
* Turner’s Syndrome

Hypergonadotrophic Hypogonadism

Question 6

• Uterus: present
• Outflow tract: patent
• Breast: undeveloped
• FSH: < 30

Answer 6

Severe Hypothalamic Dysfunction
* CDGP
* GnRH deficiency: Kallmann syndrome
* Primary hypothalamic disorder
* Functional hypogonadotropic hypogonadism

Hypogonadotropic Hypogonadism

Question 7

• Uterus: present
• Outflow tract: patent
• Breasts: developed

Answer 7

Early-onset Secondary Amenorrhea