A 27-year-old woman with secondary amenorrhoea for one year had a dilatation and curettage for retained products of conception. Hormonal profile including FSH, LH, prolactin and thyroid function is entirely normal, and progesterone withdrawal test fails to induce bleeding. Which investigation will definitively establish the cause?
- A Serum estradiol measurement
- B Hysteroscopy ✓
- C MRI of the pituitary
- D Endometrial biopsy
Correct answer: B. Hysteroscopy
Explanation
Intrauterine synechiae after uterine curettage cause Asherman syndrome: normal ovarian function with failed withdrawal bleeding because the endometrium cannot respond. Hysteroscopy is the gold standard, allowing direct visualisation and simultaneous adhesiolysis. Endometrial biopsy may sample uninvolved tissue and miss the adhesions, and pituitary imaging is irrelevant when all hormone levels are normal.
Reference: Dutta's Textbook of Gynecology, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.