Snapshot A 22-year-old female presents with increased hair growth. She reports having to shave frequently above the lip, chin, chest, and lower back. She also states not having her menses over a period of four months. Prior to this, she had a regular menses. The patient's weight is 168 lbs (76.2 kg) and height 5 feet and 1 inch (154.9 cm). On physical examination, there is increased hair above the lip and chin area. There is also acne on the cheeks and forehead. Hyperpigmented plaques of the skin are found in the back of the neck. Bilateral enlarged ovaries are palpated on pelvic examination. β-hCG is negative and LH:FSH is 3. (Polycystic ovarian syndrome) SUMMARY Absence of menses > 3 months in those with regular menses or absence of menses > 6 months in those with irregular menses Etiology pregnancy (most common) hypothalamic dysfunction login to view 10 more bullets pituitary dysfunction login to view 1 more bullet thyroid disorder login to view 1 more bullet polycystic ovarian syndrome (most common reproductive disorder in women) ovarian dysfunction login to view 1 more bullet uterine disorders login to view 1 more bullet obesity Presentation Symptoms and physical examination findings will be dependent on the etiology of secondary amenorrhea login to view 1 more bullet History login to view 1 more bullet Physical Exam login to view 1 more bullet Studies β-hCG login to view 1 more bullet Follicle-stimulating hormone (FSH), prolactin (PRL), and thyroid-stimulating hormone (TSH) login to view 2 more bullets Testosterone login to view 1 more bullet Progesterone challenge test login to view 4 more bullets Estrogen-progesterone challenge test login to view 5 more bullets Differential Diagnosis Pregnancy Contraceptive use Excessive exercise/physical stress Refer to introduction for causes of secondary amenorrhea Treatment Treatment depends on etiology of disease login to view 10 more bullets Complications Infertility Decreased bone density in patients with inadequate estrogen