Review of systems should cover symptoms suggesting possible causes, including the following: Galactorrhea, headaches, hearing loss, and visual field defects: Pituitary disorders Fatigue, weight gain, and cold intolerance: Hypothyroidism Palpitations, nervousness, tremor, and heat intolerance: Hyperthyroidism Palpitations: Anorexia nervosa with electrolyte abnormalities (eg, hypokalemia, hypomagnesemia) Acne, hirsutism, and deepening of the voice: Androgen excess For patients with secondary amenorrhea, hot flushes, vaginal dryness, sleep disturbance, fragility fractures, and decreased libido: Ovarian insufficiency Past medical history should note risk factors for the following: Functional hypothalamic amenorrhea, such as stress; chronic illness; new medications; a recent change in weight, diet, or exercise intensity; and a history or current symptoms of eating disorders Endometrial scarring (Asherman syndrome), as may occur in patients with a history of dilation and curettage (particularly if they also had a uterine infection), endometrial ablation, endometritis, obstetric injury, uterine surgery Medication history should include specific questions about current or past medications, such as the following: Medications that affect dopamine (eg, antihypertensives, antipsychotics, opioids, tricyclic antidepressants, antiseizure drugs) Cancer chemotherapy (eg, alkylating agents such as bendamustine, cyclophosphamide, and ifosfamide; busulfan; chlorambucil) Hormones that can cause virilization (eg, androgens, high-dose androgenic progestins, over-the-counter [OTC] anabolic steroids) Hormonal contraceptives Systemic corticosteroids OTC products and supplements, some of which contain bovine hormones Substance abuse, including opioid abuse, which may affect the secretion of pituitary hormones and lead to oligomenorrhea or amenorrhea Family history should include any cases of delayed puberty or genetic disorders, including Fragile X syndrome.