A 29-year-old woman presents with secondary amenorrhea for 14 months and hot flushes. FSH is 48 IU/L (on two occasions 4 weeks apart), estradiol is <20 pg/mL, and karyotype is 46,XX. Which is the most appropriate long-term management?

• A Clomiphene citrate ovulation induction
• B Combined oral contraceptive pill
• C Observation with annual FSH monitoring
• D Estrogen replacement until age 50 years ✓

Explanation

This is premature ovarian insufficiency (menopause before age 40). Estrogen replacement until the natural menopause age (~50) is recommended for bone, cardiovascular, and urogenital protection, unless contraindicated. COCP is less physiological and not first-line. Clomiphene is ineffective with follicle depletion. Observation risks osteoporosis and cardiovascular disease.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.