American Board of Family Medicine (ABFM) Practice Exam 2026 - Free ABFM Practice Questions and Study Guide

In cases of secondary amenorrhea where the physical examination is normal and pregnancy tests are negative, it is crucial to assess the endocrine status of the patient. Checking serum LH (luteinizing hormone) and FSH (follicle-stimulating hormone) levels is the appropriate next step because these hormones provide insight into the functioning of the ovaries and pituitary gland.

The LH and FSH levels help differentiate between various causes of amenorrhea. For example, low levels of both LH and FSH may indicate hypothalamic causes or central causes such as hypothalamic amenorrhea. On the other hand, elevated levels could suggest primary ovarian insufficiency or menopause. Understanding the patient's hormonal profile is essential to guide further diagnostic and management pathways appropriately.

Other options may provide useful information in specific scenarios but are not the immediate next step in a case of secondary amenorrhea after confirming negative pregnancy tests. A complete blood count (CBC) and metabolic panel may help in ruling out underlying systemic issues but won't directly address the amenorrhea's cause as effectively as hormonal assessment. Karyotype analysis is more relevant in cases of suspected genetic disorders, and pelvic ultrasonography may investigate structural abnormalities but would typically come after endocrine evaluation has been performed