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Progesterone challenge

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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This is used to assess the ability of the endometrium to respond to steroid hormones.

Medroxyprogesterone acetate - MPA - is given at 10 mg/day p.o. for 5 days.

If withdrawal bleeding occurs 5-7 days later then the endometrium must have been previously exposed to adequate levels of oestrogen, and the endometrium is able to proliferate in response to progesterone. Polycystic ovarian syndrome and hypothalamic dysfunction are the most likely causes of the amenorrhoea, the former being indicated by polycystic ovaries on ultrasound scan.

If no withdrawal bleeding occurs, give oestrogen prior to MPA. A typical regimen would be ethinyloestradiol, 50 mcg daily for 21 days with MPA 10 mg daily on days 16-21.

Withdrawal bleeding indicates an oestrogen deficiency state. This may be due to ovarian failure, indicated by raised FSH, or hypothalamic-pituitary failure.

No withdrawal bleeding after the oestrogen / progesterone regime indicates a uterine disorder.

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