Gynaecological endocrinology: secondary amenorrhoea: practice question

A OBG question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

OBG · Gynaecological endocrinology: secondary amenorrhoea

Sample item

A 22-year-old marathon runner with a BMI of 17 has had no periods for 8 months. Pregnancy test, TSH and prolactin are normal, and FSH, LH and oestradiol are low. What is the mechanism?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Reduced hypothalamic GnRH pulsatility

Low energy availability from exercise and low weight suppresses GnRH pulses, giving low gonadotropins and oestradiol (functional hypothalamic amenorrhoea). Management is weight gain and reduced exercise. Ovarian failure would raise FSH.

Option by option

  • A. Autoimmune destruction of ovarian follicles

    Ovarian autoimmunity would raise FSH, not lower it.

  • B. Raised androgens from polycystic ovaries

    Polycystic ovary syndrome shows normal or raised LH and androgen excess.

  • C. Intrauterine adhesions

    Adhesions cause amenorrhoea with normal hormone levels.

  • D. Reduced hypothalamic GnRH pulsatility (correct)

    Correct. Energy deficit suppresses GnRH pulses.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More OBG questions

Questions about this OBG question

What is the answer to this OBG question?

The best answer is D, Reduced hypothalamic GnRH pulsatility. Low energy availability from exercise and low weight suppresses GnRH pulses, giving low gonadotropins and oestradiol (functional hypothalamic amenorrhoea).

Why is "Autoimmune destruction of ovarian follicles" not the answer?

Ovarian autoimmunity would raise FSH, not lower it.

Why is "Raised androgens from polycystic ovaries" not the answer?

Polycystic ovary syndrome shows normal or raised LH and androgen excess.

Why is "Intrauterine adhesions" not the answer?

Adhesions cause amenorrhoea with normal hormone levels.

What concept does this question test?

It tests Gynaecological endocrinology: secondary amenorrhoea in OBG. Management is weight gain and reduced exercise. Ovarian failure would raise FSH.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gynaecological endocrinology: secondary amenorrhoea?

Learn management algorithms as steps: PPH, eclampsia, ectopic pregnancy. Then use the flashcards and the other OBG questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.