Question

A woman has not had a menstrual period in several months. She is not on birth control, and the pregnancy test comes back negative. Explain what a likely cause would be in the following situations:

A) Her FSH levels in the blood are very low.

B) Her FSH levels in the blood are elevated

C) Her FSH levels in the blood are normal. When estrogen and progesterone are administered and then withdrawn, she experiences menstruation.

Answer 1

FEMALE is suffering from Secondary ammenorrhea

Also rule out pregnany,hypthyroidism and prolactinoma by doing hormonal study ( TSH thyroid stimulating hormone and Prolactin levels ) Do Urine pregnancy test to look for preganancy

If everything is negative then give Trial of progesterone challenge test For 10 days and if bleeding is present then most likely cause is Polycystic ovary syndrome (PCOS) / anovulation

If bleeding is still not present then give estrogen and progesterone challenge test now if still bleeding is not present then cause is ASHERMAN syndrome and if bleeding is present then do FSH levels if it is low or normal range then most likely cause is either Hypothalamus or Pituitary and if FSH is more then most likely the cause is Premature menopause .

So in our case

​​​​A)FSH very low in

​​​1) Hypothalamus causes like stress ,exercise ,Anorexia nervosa ,Bulimia nervosa ,excessive exercise.

2 ) Pituitary Adenoma and Sheehan syndrome

B) FSH elevated in Premature menopause

C) FSH is normal in PCOS Polycystic ovarian syndrome .