In a 14-year-old female with irregular menstrual periods and a negative pregnancy test, what is the likely hormonal cause of her symptoms?

In a 14-year-old female presenting with irregular menstrual periods and a negative pregnancy test, the most likely hormonal cause of her symptoms is insufficient gonadotropin secretion. This can lead to a condition known as hypothalamic amenorrhea or functional hypothalamic amenorrhea, where the gonadotropin-releasing hormone (GnRH) is not being secreted in a regular, pulsatile fashion.

During adolescence, the hypothalamic-pituitary-ovarian (HPO) axis is still maturing. Inadequate secretion of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) due to insufficient GnRH can result in irregular or absent menstrual periods. The body may not produce enough estrogen, leading to the failure of normal ovarian function and resulting in irregular cycles.

The other factors mentioned, such as hyperprolactinemia, can cause menstrual irregularities but would usually present with other symptoms (e.g., galactorrhea). Polycystic ovarian syndrome (PCOS) is another condition that can cause irregular menstrual cycles, often linked with insulin resistance and elevated androgens, but it typically occurs with additional symptoms like hirsutism or obesity. Excess progesterone