A 26-year-old woman with PCOS presents with secondary amenorrhoea of 9 months duration. Transvaginal ultrasound shows an endometrial thickness of 14 mm. What is the most appropriate next step in her management?
- A Progestogen challenge to induce withdrawal bleeding ✓
- B Combined oral contraceptive pill alone
- C Endometrial biopsy
- D Gonadotropin stimulation for ovulation induction
Correct answer: A. Progestogen challenge to induce withdrawal bleeding
Explanation
Chronic anovulation in PCOS leaves the endometrium exposed to unopposed oestrogen, producing a thickened endometrium. The immediate priority is to induce a withdrawal bleed with a progestogen course to prevent endometrial hyperplasia, then establish long-term cycle control with cyclical progestogens or a combined pill. Endometrial biopsy is reserved for women over 45 or those with persistent bleeding after treatment.
Reference: Williams Gynecology, 4th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.