Progesterone withdrawal test to exclude various types of amenorrhea

Ms. Liu, 26 years old, unmarried, has been menopausal for 5 years. She usually has heavy menstruation and thin menstruation. She stopped menstruating 5 years ago due to a change in her living environment. After menopause, she gained weight significantly, had high blood pressure, diabetes, memory loss, and hair loss. Last year, she was examined in the Endocrinology Department of Capital Hospital and was initially diagnosed with adrenal and pituitary lesions. In March and April this year, she received pituitary radiotherapy in the hospital. During this period of menopause, Ms. Liu often felt dizzy, tinnitus, palpitations, chest tightness, abdominal distension, and back and leg pain.

To treat amenorrhea, doctors prescribed a progestin withdrawal trial.

Progesterone injection, 20 mg per day, intramuscular injection, for 5 consecutive days. After stopping the medication, Ms. Liu had no withdrawal bleeding, a negative reaction, and the doctor diagnosed her with II degree amenorrhea. Next, an estrogen-progesterone sequential test was performed.

Estrogen can be taken orally with estradiol valerate 2 mg or conjugated estrogen (Premarin) 1.25 mg daily for 21 consecutive days. After 10 days, medroxyprogesterone 10 mg daily can be added orally. Withdrawal bleeding after discontinuation of the medication is positive, indicating that the endometrium is functioning normally. Excluding uterine amenorrhea, the cause of amenorrhea is low estrogen levels in the body, and the cause should be further investigated.