Choosing Wisely:

Don’t obtain a karyotype as part of the initial evaluation for amenorrhea.

Rationale and Comments: Amenorrhea is the absence of menstruation and can be attributed to many causes. A karyotype (chromosomal analysis) is not indicated as an initial test for amenorrhea as it is not a screening test. However, it is indicated to further evaluate the etiology of an elevated follicle-stimulating hormone in a woman under 40 years of age or in the presence of physical findings suggestive of disorders of sexual development.
Sponsoring Organizations:
  • American Society for Reproductive Medicine
  • Sources:
  • Expert consensus
  • Disciplines:
  • Gynecologic
  • References: • Baker VL. Primary ovarian insufficiency in the adolescent. Curr Opin Obstet Gynecol. 2013 Oct;25(5):375-81.
    • Nelson LM, Covington SN, Rebar RW. An update: spontaneous premature ovarian failure is not an early menopause. Fertil Steril. 2005 May;83(5):1327–32.
    • Bachmann GA, Kemmann E. Prevalence of oligomenorrhea and amenorrhea in a college population. Am J Obstet Gynecol. 1982 Sep 1;144(1):98–102.
    • Reindollar RH, Byrd JR, McDonough PG. Delayed sexual development: a study of 252 patients. Am J Obstet Gynecol. 1981 Jun 15;140(4):371–80.
    • Reindollar RH, Novak M, Tho SP, McDonough PG. Adult-onset amenorrhea: a study of 262 patients. Am J Obstet Gynecol. 1986 Sep;155(3):531–43.
    • Klein DA, Poth MA. Amenorrhea: an approach to diagnosis and management. Am Fam Physician. 2013 Jun 1;87(11):781–8.

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