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Progestogen challenge test

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Progestin challenge, or progesterone withdrawal test is a test used in the field of obstetrics and gynecology in order to evaluate a patient who is experiencing amenorrhea. Due to readily available assays to measure serum estradiol levels, this test is now rarely used.[1] The test is performed by administering progesterone orally in the form of medroxyprogesterone acetate (Provera), or intramuscularly. If the patient has sufficient serum estradiol (greater than 50 pg/mL) then withdrawal bleeding should occur 2-7 days after the progestin is finished, indicating that the patient's amenorrhea is due to anovulation. However, if no bleeding occurs after progesterone withdrawal, then the patient's amenorrhea is likely to be due to either a) low serum estradiol, b) hypothalamic-pituitary axis dysfunction, c) a nonreactive endometrium or d) a problem with the uterine outflow tract, such as cervical stenosis or uterine synechiae (Asherman's syndrome). In order to distinguish between hypoestrogenism or a uterine outflow tract problem/nonreactive endometrium, estrogen may be administered followed by a course of progestin in order to induce withdrawal bleeding. If the patient experiences withdrawal bleeding with the combined estrogen/progestin therapy, then the amenorrhea is likely due to low estrogen.[2]


Indications Amenorrhea evaluation Procedure: Progesterone Challenge Administer Progesterone (options below) Provera 10 mg PO once daily 7-10 days or Norethindrone 5 mg PO once daily for 7-10 days or Progesterone 200 mg IM for one dose or Micronized Progesterone 400 mg oral qd x7-10 days or Progesterone micronized gel (4 to 8%) or Apply intravaginally every other day for 6 doses Assess for Menstrual Bleeding after Progesterone Anticipate within 7 days of Progesterone completion Interpretation Withdrawal bleeding within 7 days Suggests Anovulation with Progesterone deficiency See Normogonadotropic Hypogonadism for causes Endometrial Cancer risk with Unopposed Estrogen Requires Progesterone replacement No withdrawal bleeding Perform Estrogen-Progesterone Challenge Test No withdrawal bleed suggests outflow obstruction [br]Obtain Serum FSH, Serum LH, Free testosterone (FT) level, TSH, Prolactin level.[/br] [br]FSH>20 and LH>40: Hypergonadotropic Hypogonadism[/br] [br]FSH and LH<5: Hypogonadotropic Hypogonadism[/br] [br]Elevated FT, LH 1.5-2x>FSH: Polycystic Ovarian Syndrome is likely.[/br]


See also

References

  1. ^ "eMedicine - Amenorrhea, Secondary: Differential Diagnoses & Workup". eMedicine.com. Retrieved 2010-05-02.
  2. ^ "Progesterone Withdrawal Test". Advanced Fertility Center of Chicago. Retrieved 2010-05-02.
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