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OB/GYN
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AUB / Secondary Amenorrhea — Age-Based
Flowchart
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<45 vs ≥45 changes the workup tier.
Decision
Outcome
Decision
AUB or secondary amenorrhea — age?
✓
<45 → β-hCG, FSH, TSH, prolactin
✓
≥45 → β-hCG; if not pregnant, TSH and prolactin only in select cases; endometrial biopsy if abnormal bleeding
Decision
β-hCG?
✓
Positive → pregnancy
✓
Negative → routine evaluation with FSH/TSH/prolactin
Outcome
Pregnant — obstetric care
Outcome
Treat hormonal cause per labs
Decision
Age ≥45 result?
✓
Perimenopausal — endometrial biopsy if abnormal bleeding pattern
Outcome
Rule out endometrial hyperplasia/cancer; treat per finding