A 30-year-old woman develops secondary amenorrhoea after a dilatation and curettage for retained products of conception. FSH, LH, estradiol, prolactin and TSH are all normal. Progestogen challenge fails to induce withdrawal bleeding. What does this pattern indicate?

• A Ovarian failure
• B Outflow tract obstruction at the cervix only
• C Hypothalamic amenorrhoea
• D Intrauterine adhesions (Asherman syndrome) ✓

Explanation

With normal gonadotrophins and oestradiol, the hypothalamic-pituitary-ovarian axis is intact. Failure of withdrawal bleeding after progestogen means the endometrium cannot respond, pointing to endometrial destruction or scarring. Curettage causing damage to the basalis layer with synechiae formation is the classic cause of Asherman syndrome. Ovarian failure would show raised FSH, hypothalamic amenorrhoea would show low gonadotrophins, and an isolated cervical obstruction would not explain the absent response to systemic hormones.

Reference: Williams Gynecology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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