Question:medium
A 36-year-old P2L2 woman with 9 months of secondary amenorrhea has FSH 36, LH 56, and AMH 0.5. What is the diagnosis?
A 36-year-old P2L2 woman with 9 months of secondary amenorrhea has FSH 36, LH 56, and AMH 0.5. What is the diagnosis?
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Amenorrhea with high FSH and low AMH in a woman under 40 years = premature ovarian failure.
Updated On: May 14, 2026
- PCOS
- Premature ovarian failure
- Hyperprolactinemia
- Hypothalamic amenorrhea
Show Solution
The Correct Option is B
Solution and Explanation
Step 1: Understanding the Question:
This clinical scenario involves a woman under the age of 40 presenting with significant secondary amenorrhea (9 months) and biochemical evidence of exhausted ovarian reserve.
Step 2: Detailed Explanation:
Definition of POF/POI: Premature Ovarian Failure (now often called Premature Ovarian Insufficiency) is the cessation of ovarian function before age 40, characterized by amenorrhea, low estrogen, and high gonadotropins.
Hormonal Analysis: The patient's FSH level of 36 IU/L and LH of 56 IU/L are in the postmenopausal range.
This indicates hypergonadotropic hypogonadism, where the pituitary is over-secreting FSH/LH because the ovaries are not producing enough estrogen or inhibin to provide negative feedback.
Ovarian Reserve (AMH): An Anti-Müllerian Hormone (AMH) level of 0.5 ng/mL is very low, indicating a severely depleted primordial follicle pool.
Differential Diagnosis: In PCOS, FSH is typically low or normal while AMH is very high.
In Hypothalamic Amenorrhea, both FSH and LH would be very low (hypogonadotropic hypogonadism).
Hyperprolactinemia would present with elevated Prolactin levels and usually suppresses gonadotropins rather than elevating them.
Step 3: Final Answer:
The combination of age < 40, secondary amenorrhea, high FSH, and low AMH confirms the diagnosis of Premature Ovarian Failure.
This clinical scenario involves a woman under the age of 40 presenting with significant secondary amenorrhea (9 months) and biochemical evidence of exhausted ovarian reserve.
Step 2: Detailed Explanation:
Definition of POF/POI: Premature Ovarian Failure (now often called Premature Ovarian Insufficiency) is the cessation of ovarian function before age 40, characterized by amenorrhea, low estrogen, and high gonadotropins.
Hormonal Analysis: The patient's FSH level of 36 IU/L and LH of 56 IU/L are in the postmenopausal range.
This indicates hypergonadotropic hypogonadism, where the pituitary is over-secreting FSH/LH because the ovaries are not producing enough estrogen or inhibin to provide negative feedback.
Ovarian Reserve (AMH): An Anti-Müllerian Hormone (AMH) level of 0.5 ng/mL is very low, indicating a severely depleted primordial follicle pool.
Differential Diagnosis: In PCOS, FSH is typically low or normal while AMH is very high.
In Hypothalamic Amenorrhea, both FSH and LH would be very low (hypogonadotropic hypogonadism).
Hyperprolactinemia would present with elevated Prolactin levels and usually suppresses gonadotropins rather than elevating them.
Step 3: Final Answer:
The combination of age < 40, secondary amenorrhea, high FSH, and low AMH confirms the diagnosis of Premature Ovarian Failure.
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