II. Indications

  1. Secondary Amenorrhea evaluation
  2. No withdrawal bleeding with Progesterone Challenge Test

III. Procedure

  1. Administer Estrogen-Progesterone (options below)
    1. Premarin 1.25 mg orally daily for 21 days or
    2. Oral Contraceptive for 2 Cycles or
    3. Estradiol 2 mg orally daily for 21 days and
      1. Follow with 7-10 days of Progesterone
      2. See Progesterone Challenge Test for options
  2. Assess for Menstrual Bleeding after stopping medication
    1. Anticipate within 7 days of medication completion

IV. Interpretation

  1. No withdrawal bleeding occurs
    1. Suggests uterine bleeding outflow obstruction
  2. Withdrawal bleeding (but not after Progesterone alone)
    1. Obtain Serum FSH and Serum LH
      1. FSH>20 and LH>40: Hypergonadotropic Hypogonadism
      2. FSH and LH<5: Hypogonadotropic Hypogonadism

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