Step twoexclude hyperthyroidism and hyperprolactinemia

1. Hypothyroidism and hyperprolactinemia can cause amenorrhea. These disorders are excluded with a serum thyroid-stimulating hormone (TSH) and prolactin.

2. Hyperprolactinemia. Prolactin inhibits the secretion of gonadotropin-releasing hormone. One-third of women with no obvious cause of amenorrhea have hyperprolactinemia. Mildly elevated prolactin levels should be confirmed by repeat testing and review the patient's medications. Hyperprolactinemia requires an MRI to exclude a pituitary tumor.

Drugs Associated with Amenorrhea

Drugs that Increase Prolactin

Antipsychotics Tricyclic antidepressants Calcium channel blockers

Drugs with Estrogenic Activity

Digoxin, marijuana, oral contraceptives

Drugs with Ovarian Toxicity

Chemotherapeutic agents

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Breaking Bulimia

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