Which of the following are useful investigations for the direct physiological and structural evaluation of the uterine cavity and target-organ responsiveness as a cause of primary amenorrhoea? Karyotype Progesterone challenge test Hormonal studies Hysterosalpingography Select the correct answer using the code given below.
2. Progesterone Challenge Test: This is a direct physiological test of the endometrium. If a patient experiences withdrawal bleeding after receiving progesterone, it proves that the endometrium is responsive and has already been successfully primed by endogenous estrogen. A lack of bleeding points directly to target-organ failure or an anatomical blockage.
3. Hormonal Studies: To diagnose an "unresponsive" endometrium, you must first confirm that the signaling hormones (FSH, LH, Estrogen) are interacting correctly with it. For instance, if estrogen levels are normal or elevated but the endometrium fails to proliferate, it directly isolates endometrial unresponsiveness as the underlying pathology rather than an ovarian or hypothalamic failure.
4. Hysterosalpingography (HSG): This structural investigation directly images the shape and interior architecture of the uterine cavity. It is crucial for identifying severe congenital hypoplasia or extensive intrauterine synechiae (scar tissue), both of which cause the endometrium to become completely unresponsive to hormonal stimulation.
Why Karyotype (1) Is Excluded
While a Karyotype is an essential baseline test in the overarching algorithm for primary amenorrhea to check for conditions like Turner syndrome ($45,X$), it is a genetic test. It does not provide information regarding the direct physiological response, chemical status, or immediate physical architecture of the uterine cavity.
Therefore, Option 4 (2, 3 and 4) is mathematically and clinically flawless under this corrected framework.
Important Questions from Physiology of Menstruation & Fertilization
- Implantation of a fertilised ovum occurs on which day following fertilisation?
- Withdrawal bleeding following administration of progesterone in a case of secondary amenorrhea indicates all EXCEPT:
- Diagnostic criteria for PCOD are:
1. Oligo/amenorrohoea
2. Hyperandrogenism
3. Polycystic ovaries on ultrasound
Which of the above are correct? An 18 year old unmarried girl comes with complaints of heavy, prolonged bleeding during menses. Which among the following investigations is NOT usually advised?
- Which one of the following is true about Basal body temperature?
1. Biphasic pattern
2. Increase in the level of progesterone and norepinephrine
3. Temperature falls by $0.5^{\circ}C$ after ovulation
4. It can predict ovulation precisely
Select the correct answer using the code given below:
