A 32-year-old woman presents with secondary amenorrhea for 10 months, hot flushes, and vaginal dryness. Serum FSH is 52 IU/L (on two occasions 4 weeks apart), estradiol is 12 pg/mL, and prolactin and TSH are normal. What is the most appropriate diagnosis?
- A Menopause
- B Hypothalamic amenorrhea
- C Premature ovarian insufficiency ✓
- D Resistant ovary syndrome
Correct answer: C. Premature ovarian insufficiency
Explanation
Premature ovarian insufficiency (POI) is diagnosed by amenorrhea for at least 4 months with FSH greater than 25 IU/L on two occasions at least 4 weeks apart in a woman under 40 years. Menopause is a clinical diagnosis after 12 months of amenorrhea and is age-dependent (average 51 years). Hypothalamic amenorrhea shows low or normal FSH. Resistant ovary syndrome shows elevated FSH but with normal follicles on biopsy. Karyotype testing is indicated in POI to rule out Turner mosaicism. (NICE NG23 on Menopause; ESHRE guideline on POI).
Reference: Williams Gynecology, 4th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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