Use of the progestin challenge test in diagnosing amenorrhea: the time has come to say goodbye
Volume 113, Issue 1, Pages 51–52
William D. Schlaff, M.D., Charles C. Coddington, M.D.
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.