Findings	Associations
Patient history
Exercise, weight loss, current or previous chronic illness, illicit drug use	Hypothalamic amenorrhea
Menarche and menstrual history	Primary versus secondary amenorrhea
Prescription drug use	Multiple, depending on medication
Previous central nervous system chemotherapy or radiation	Hypothalamic amenorrhea
Previous pelvic radiation	Premature ovarian failure
Psychosocial stressors; nutritional and exercise history	Anorexia or bulimia nervosa
Sexual activity	Pregnancy
Family history
Genetic defects	Multiple causes of primary amenorrhea
Pubic hair pattern	Androgen insensitivity syndrome
Infertility	Multiple
Menarche and menstrual history (mother and sisters)	Constitutional delay of growth and puberty
Pubertal history (e.g., growth delay)	Constitutional delay of growth and puberty
Physical examination
Anthropomorphic measurements; growth chart	Constitutional delay of growth and puberty
Body mass index	Polycystic ovary syndrome
Dysmorphic features (e.g., webbed neck, short stature, widely spaced nipples)	Turner’s syndrome
Rudimentary or absent uterus; pubic hair	Müllerian agenesis
Striae, buffalo hump, significant central obesity, easy bruising, hypertension, or proximal muscle weakness	Cushing’s disease
Tanner staging (Table 1)	Primary versus secondary amenorrhea
Thyroid examination	Thyroid disease
Transverse vaginal septum; imperforate hymen	Outflow tract obstruction
Undescended testes; external genital appearance; pubic hair	Androgen insensitivity syndrome
Virilization; clitoral hypertrophy	Androgen-secreting tumor
Review of systems
Anosmia	Kallmann syndrome
Cyclic abdominal pain; breast changes	Outflow tract obstruction or müllerian agenesis
Galactorrhea; headache and visual disturbances	Pituitary tumor
Hirsutism or acne	Polycystic ovary syndrome
Signs and symptoms of hypothyroidism or hyperthyroidism	Thyroid disease
Vasomotor symptoms	Premature ovarian failure