A 30-year-old woman has secondary amenorrhea for 6 months and a history of two dilation and curettage procedures following a missed miscarriage at 14 weeks. Serum FSH is 7 IU/L, estradiol is 80 pg/mL, and progesterone challenge test shows no withdrawal bleeding. Transvaginal ultrasound reveals a thin endometrium of 3 mm. What is the most likely diagnosis?
- A Asherman syndrome (intrauterine adhesions) ✓
- B Hypothalamic amenorrhea
- C Premature ovarian insufficiency
- D Sheehan syndrome
Correct answer: A. Asherman syndrome (intrauterine adhesions)
Explanation
Normal FSH and estradiol rule out ovarian failure and hypothalamic causes. The absence of withdrawal bleeding after progesterone challenge indicates a non-responsive endometrium, and the history of post-miscarriage curettage points to intrauterine adhesions (Asherman syndrome). Sheehan syndrome follows postpartum hemorrhage with panhypopituitarism and would show low FSH and estradiol. Hysteroscopy is diagnostic. (Berek and Hacker's Gynecologic Oncology; ACOG Practice Bulletin on Asherman syndrome).
Reference: Berek and Hacker's Gynecologic Oncology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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