Question:medium
A lady presented with secondary amenorrhea 6 months after having an abortion. Her FSH level was measured as 6 mIU/ml. What is the most probable diagnosis?
A lady presented with secondary amenorrhea 6 months after having an abortion. Her FSH level was measured as 6 mIU/ml. What is the most probable diagnosis?
Show Hint
Normal FSH after a curettage points to the cavity, not the ovary or pituitary.
Updated On: Jun 24, 2026
- Pituitary failure
- Ovarian failure
- Fresh pregnancy
- Uterine synechiae
Show Solution
The Correct Option is D
Solution and Explanation
Solve this by separating the two clues. Clue one is timing, the periods stopped right after an abortion. Clue two is the FSH of 6 mIU/ml, which is squarely in the normal range.
Start with the FSH because it is a fast filter. A failing ovary loses its negative feedback and the pituitary drives FSH sky high, typically far above 40. A failing pituitary cannot secrete gonadotropins, so FSH drops to very low levels. A value of 6 sits in neither camp, so both the ovary and the pituitary are functioning normally. That eliminates options A and B in one stroke.
Now the history takes over. Instrumentation of the uterus during evacuation can strip the basal endometrium and let raw surfaces adhere, sealing the cavity. The hormones still cycle, but there is no responsive lining and no outflow, so menstruation stops. This is Asherman syndrome, also called intrauterine synechiae. Fresh pregnancy could in theory cause amenorrhea, but the stem is built around a normal FSH after a curettage, which is the textbook setup for adhesions, and a beta-hCG would quickly exclude pregnancy.
$Normal\ FSH + post\ curettage\ amenorrhea \Rightarrow intrauterine\ adhesions$
\[\boxed{Uterine\ synechiae}\]
Start with the FSH because it is a fast filter. A failing ovary loses its negative feedback and the pituitary drives FSH sky high, typically far above 40. A failing pituitary cannot secrete gonadotropins, so FSH drops to very low levels. A value of 6 sits in neither camp, so both the ovary and the pituitary are functioning normally. That eliminates options A and B in one stroke.
Now the history takes over. Instrumentation of the uterus during evacuation can strip the basal endometrium and let raw surfaces adhere, sealing the cavity. The hormones still cycle, but there is no responsive lining and no outflow, so menstruation stops. This is Asherman syndrome, also called intrauterine synechiae. Fresh pregnancy could in theory cause amenorrhea, but the stem is built around a normal FSH after a curettage, which is the textbook setup for adhesions, and a beta-hCG would quickly exclude pregnancy.
$Normal\ FSH + post\ curettage\ amenorrhea \Rightarrow intrauterine\ adhesions$
\[\boxed{Uterine\ synechiae}\]
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