A 26-year-old woman has secondary amenorrhoea for 8 months. Pregnancy is excluded, serum TSH and prolactin are normal, and there is no galactorrhoea. She is given medroxyprogesterone acetate 10 mg daily for 5 days and develops withdrawal bleeding within a week. This response indicates:

• A Chronic anovulation with adequate endogenous oestrogen ✓
• B Hypothalamic-pituitary failure with hypo-oestrogenism
• C Outflow tract abnormality such as Asherman syndrome
• D Premature ovarian insufficiency

Explanation

Withdrawal bleeding after a progestin challenge requires an oestrogen-primed endometrium, so it confirms adequate endogenous oestrogen and an intact outflow tract. The diagnosis is therefore eugonadal anovulation, classically PCOS. Absence of withdrawal bleeding would prompt an oestrogen-progestin challenge: bleeding then points to hypothalamic-pituitary disease or premature ovarian insufficiency, while no bleeding even after oestrogen priming suggests Asherman syndrome.

Reference: Williams Gynecology, 4th ed.

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Written and medically reviewed by the StethoPrep medical team.