II. Indications

  1. Amenorrhea evaluation

III. Procedure: Progesterone Challenge

  1. Administer Progesterone (options below)
    1. Provera 10 mg PO once daily 7-10 days or
    2. Norethindrone 5 mg PO once daily for 7-10 days or
    3. Progesterone 200 mg IM for one dose or
    4. Micronized Progesterone 400 mg oral qd x7-10 days or
    5. Progesterone micronized gel (4 to 8%) or
      1. Apply intravaginally every other day for 6 doses
  2. Assess for Menstrual Bleeding after Progesterone
    1. Anticipate within 7 days of Progesterone completion

IV. Interpretation

  1. Withdrawal bleeding within 7 days
    1. Suggests Anovulation with Progesterone deficiency
    2. See Normogonadotropic Hypogonadism for causes
    3. Endometrial Cancer risk with Unopposed Estrogen
      1. Requires Progesterone replacement
  2. No withdrawal bleeding
    1. Perform Estrogen-Progesterone Challenge Test
      1. No withdrawal bleed suggests outflow obstruction
    2. 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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