A 26-year-old woman has secondary amenorrhea for 5 months. Pregnancy is excluded. She receives medroxyprogesterone acetate 10 mg daily for 7 days and develops withdrawal bleeding within a week of stopping. What does this result establish?
- A Endogenous estrogen production is adequate and the outflow tract is patent, pointing to a cause such as chronic anovulation ✓
- B The amenorrhea is due to hypoestrogenism, so further testing should proceed to the estrogen-progestin challenge
- C The endometrium is unresponsive, consistent with intrauterine adhesions
- D She has premature ovarian insufficiency and needs immediate karyotyping
Correct answer: A. Endogenous estrogen production is adequate and the outflow tract is patent, pointing to a cause such as chronic anovulation
Explanation
Withdrawal bleeding after progestin alone requires two conditions: an adequately estrogen-primed endometrium and a patent cervical canal and uterine cavity. Its presence therefore rules out both significant hypoestrogenism and Asherman syndrome, and the commonest remaining explanation is anovulatory states such as PCOS. If no bleeding occurred, an estrogen-progestin challenge would follow: bleeding then implies hypoestrogenism, while continued absence of bleeding indicates an outflow tract defect.
Reference: Speroff's Clinical Gynecologic Endocrinology and Infertility, 9th ed.
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