A 29-year-old woman has secondary amenorrhoea for 7 months. Serum FSH is 38 IU/L and estradiol is low. Repeat FSH after 5 weeks is 41 IU/L. Prolactin and TSH are normal. What is the most likely diagnosis?

• A Functional hypothalamic amenorrhoea
• B Premature ovarian insufficiency ✓
• C Sheehan syndrome
• D Polycystic ovary syndrome

Explanation

Premature ovarian insufficiency is defined as loss of ovarian function before age 40 with amenorrhoea and elevated FSH. The accepted diagnostic threshold is FSH above 25 IU/L measured on two occasions at least 4 to 6 weeks apart, which this patient fulfils. Hypothalamic amenorrhoea and Sheehan syndrome produce low gonadotrophins, and PCOS typically shows normal or mildly raised LH with oligomenorrhoea rather than sustained FSH elevation.

Reference: Williams Gynecology, 4th ed.

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