Def. menstrual cycle longer than 35 days

• Less frequent
• Lighter flow

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Step 1: Rule out Pregnancy

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Presentation

Female Sex Physiology

Overall Approach

Physical Exam

• Tanner Stages (I-IV)

Investigations

1. Investigate ovulation
   1. Cervical Mucus change
   2. Body Temperature Tracker
   3. Progesterone in serum in luteal phase
   4. Urine Progesterone Level → detect LH surge
2. Investigate estrogenization
   • Progesterone Suppression test
3. Investigate causes of secondary Oligo-amenorrhea
   • b-HCG
   • FSH, LH
   • BMI (18.5 - 25)
   • TSH (< 5)
   • Prolactin
   • Testosterone
   • AMH, Fasting Glucose, HbA1c (< 6.5), Fasting Insulin

Imaging

Pelvic US (uterus and ovary)

Brain MRI (if sus. pituitary cause)

Bone Age, DXA