A 29-year-old woman presents with secondary amenorrhea for 10 months, hot flushes, and dyspareunia. Serum FSH is 52 IU/L (repeated 6 weeks later: 48 IU/L), estradiol is 12 pg/mL, and prolactin and thyroid function are normal. Which diagnosis best explains this presentation?

• A Premature ovarian insufficiency ✓
• B Functional hypothalamic amenorrhea
• C Natural menopause
• D Primary hypothyroidism

Explanation

Premature ovarian insufficiency is defined as hypergonadotropic amenorrhea (FSH >25-40 IU/L on two occasions) with low estradiol in a woman under 40 years. Age 29 with menopausal-range FSH and estradiol fits this definition. Natural menopause at 29 is exceedingly rare. Functional hypothalamic amenorrhea produces low or normal FSH and low estradiol, not elevated FSH. Hypothyroidism would show abnormal TSH.

Reference: Williams Gynecology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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