Amenorrhea - etiologic approach to diagnosis

Amenorrhea is a ubiquitous problem, and clearly tangible causes are evident only in a relatively small number of patients. The clinician should proceed cautiously and select appropriate laboratory studies which will be of maximal benefit to the patient. While the evaluation of endogenous estrogen, skull x-rays, and serum gonadotropin levels are in progress, a continued dialogue with the patient must continue in order to identify factors that may contribute to psychogenic amenorrhea. Continued studies in the area of neuroendocrinology may help to clarify the relationship between the functions of the neocortex and gonadotropin production. Advancements in this area should help the clinician in his attempts to separate dysfunction from organic pathology. Meanwhile, the approach to amenorrhea should be tempered by a constant vigilance for pituitary tumors. The physician must always be aware of the role of psychosocial and nutritional factors in the interruption of the cyclic mechanism.