In a case of secondary amenorrhea who fails to get withdrawl bleeding after taking E and P, the fault lies at the level of :
Ans. is d i.e. Endometrium Read the question carefully, it says absence of withdraw! bleeding after estrogen-progesterone challenge test. Oestrogen progesterone challenge test Procedure : Ethinyl estradiol (.02 mg) or conjugated equine estrogen (1.25 mg) is given daily for 25 days. Medroxy progesterone acetate 10mg daily is added from day 15 - 25 (Alternatively estrogen is given for 21 days and progesterone is added in last 5 days). The test creates a condition similar to normal Menstrual cycle Withdraw! bleeding occurs Means endometrium and outflow tract are normal and if provided by normal hormonal levels, result in menstruation. Defect lies in production of estrogen i.e. either in ovare/Pituitarya/Hypothalamus No withdraw! bleeding Means their is a defect in endometriumdeg or outflow tractdeg (As despite normal hormonal sequence no bleeding occurs).
Pituitary
Hypothalamus
Ovary
Endometrium