Use of the progestin challenge test in diagnosing amenorrhea: the time has come to say goodbye
Inklings
Volume 113, Issue 1, Pages 51–52
Authors:
William D. Schlaff, M.D., Charles C. Coddington, M.D.
Abstract:
The evaluation of amenorrhea, whether primary or secondary, has long been inconsistent, confused, or both for many practitioners. As we consider diagnostic paradigms commonly pursued today, it is useful to consider the genesis as well as the longstanding applicability and value of the commonly employed progestin challenge test. To our knowledge, the progestin challenge test became a widely used and standard diagnostic test following publication of a textbook, Clinical Gynecologic Endocrinology and Infertility, by Drs. Speroff, Glass, and Kase in 1973 (1). This team of reproductive endocrinologists made a profound contribution to clinicians by describing an organized, “compartmentalized” approach to the diagnosis of amenorrhea. One of the key components of this diagnostic cascade was the administration of a progestational agent which would be expected to induce secretory transition of an estrogenized endometrium and produce withdrawal vaginal bleeding in women whose uterovaginal anatomy was normal and intact. The presence of bleeding was (and continues to be) indicative of chronic, estrogenized anovulation. Conversely, the absence of bleeding in non-pregnant patients was to be interpreted as reflective of hypoestrogenism, an abnormal or congenitally absent outflow tract, or (left unsaid) failure of the patient to take the medication.
Comments
Thank you for this thoughtful reflection of the history and relevance of the progestin challenge test. Twenty years from now, many of the tests we employ today will also become historic relics. It is great to see an article both acknowledging the important of a test and its modern clinical irrelevance. This is progress. Understanding the endocrine principals that underpin a test is still important to our fellows, even if the test itself no longer has clinical utility.
Kudos to Dr. Speroff for shaping our specialty and to those who take the torch for the next generation.
I always enjoy reading articles that provide a historical perspective of our field and answer questions such as where are we? why are we here? and where are we going?. Significant progress has been made in this as well as other practices within our field due to technological developments and incorporation of these technologies into everyday practice. Our foundations are solid but we are also excited to be living in an era of constant change that will continue to improve the way we practice and push our field forward.