A 32-year-old woman presents with secondary amenorrhea for 14 months following a complicated delivery with postpartum hemorrhage requiring manual removal of placenta. Progesterone challenge test shows no withdrawal bleeding, and combined estrogen-progestin challenge also fails to induce bleeding. Serum FSH, LH, and estradiol are within normal limits. What is the most likely diagnosis?

• A Sheehan syndrome
• B Hypothalamic amenorrhea
• C Premature ovarian insufficiency
• D Asherman syndrome ✓

Explanation

Asherman syndrome (intrauterine adhesions) classically presents with secondary amenorrhea or hypomenorrhea following uterine instrumentation, particularly postpartum curettage. Normal gonadotropins and estradiol exclude ovarian failure and hypothalamic causes. The failure of both progesterone and estrogen-progestin challenge to induce bleeding indicates a uterine (endometrial) cause. Sheehan syndrome involves panhypopituitarism with low FSH and LH.

Reference: High Risk Pregnancy: Management Options, 5th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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