AMENORRHEA Amenorrhea Low/Normal FSH Elevated FSH Bleed With Progestin ChallengeHypothalamic- Pituitary Axis No Bleed With Progestin Challenge High ProlactinFailed Progestin Challenge Congenital GnRH Deficiency Infiltrative or Inflammatory LesionTumors Infarction Empty Sella Syndrome Apoplexy Rule Out Pregnancy Organic Cause Hypothyroidism Hyperthyroidism Diabetes Mellitus Exogenous Androgen Use Congenital Structural Abnormalities Hyperprolactinemia Functional Hypothalamic Amenorrhea (e.g.Weight Loss, Eating Disorders, Exercise, Stress, Prolonged Illness) Premature Ovarian Failure Menopause Spontaneous Polycystic Ovarian SyndromeIf bleed with progestin challenge = estrogenizedIf no bleed with progestin challenge = non-estrogenized

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