A 31-year-old woman underwent dilatation and curettage for retained products of conception 8 months ago. Since then she has had absent menses but regular monthly cyclical lower abdominal pain. Hormonal profile including FSH, LH, prolactin and thyroid function is normal. Progesterone challenge fails to induce withdrawal bleeding. What is the most likely diagnosis?

• A Functional hypothalamic amenorrhoea
• B Premature ovarian insufficiency
• C Intrauterine synechiae (Asherman syndrome) ✓
• D Cervical pregnancy

Explanation

Curettage can denude the basalis layer, causing intrauterine adhesions that obstruct the endometrial cavity. The hallmark is amenorrhoea or hypomenorrhoea with cyclical pain, normal ovarian hormones, and failure of withdrawal bleeding to both progesterone and oestrogen-progestogen challenge because the target endometrium is destroyed or scarred. Normal gonadotropins exclude hypothalamic and ovarian causes.

Reference: Williams Gynecology, 3rd ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.