A 34-year-old woman has secondary amenorrhoea for 6 months after a dilation and curettage performed for retained products of conception. Her FSH, LH, estradiol, prolactin and TSH are all normal. Progestogen challenge test fails to induce withdrawal bleeding, and she also fails to bleed after combined estrogen-progestogen challenge. What is the most likely diagnosis?

• A Premature ovarian insufficiency
• B Hypothalamic amenorrhoea
• C Intrauterine adhesions (Asherman syndrome) ✓
• D Sheehan syndrome

Explanation

Failure to bleed after both a progestogen challenge and an estrogen-progestogen challenge indicates an outflow tract problem despite normal ovarian function, and curettage is the classic antecedent of intrauterine synechiae. In ovarian failure the gonadotropins would be elevated; in hypothalamic amenorrhoea estrogen-progestogen challenge typically induces bleeding because the endometrium is intact but understimulated.

Reference: Williams Gynecology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.