A 33-year-old woman has secondary amenorrhoea for 7 months. Serum FSH is 48 IU/L and LH is 22 IU/L, repeated 5 weeks later with FSH 45 IU/L. Estradiol is low. She has never received chemotherapy or pelvic radiotherapy. Which is the MOST likely diagnosis?

• A Premature ovarian insufficiency ✓
• B Hypothalamic amenorrhoea (WHO group I)
• C Polycystic ovarian syndrome (WHO group II)
• D Asherman syndrome

Explanation

Premature ovarian insufficiency is defined as loss of ovarian activity before age 40, with at least 4 months of amenorrhoea and two FSH levels in the menopausal range, classically above 40 IU/L, measured 4 to 6 weeks apart. Both values here qualify. Hypothalamic amenorrhoea gives low gonadotropins, PCOS gives normal or high LH with normal FSH, and Asherman syndrome gives normal gonadotropins with a normal hormonal profile but intrauterine adhesions.

Reference: Berek and Novak's Gynecology, 16th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.