Diagnostic strategies for amenorrhea.

The diagnosis of amenorrhea may be perplexing because of the sheer number of possible causes and the complexity of the structures involved (ie, the CNS-pituitary-ovarian axis). By using the same approach with all amenorrheic patients, rather than classifying them according to primary and secondary amenorrhea, physicians can narrow the diagnostic possibilities quickly and avoid unnecessary and expensive laboratory testing. Referral to a gynecologist or an endocrine specialist is recommended when the workup becomes overly complex.