Question

A lady presented with secondary amenorrhea 6 months after having an abortion. Her FSH level was measured as 6 mIU/ml. What is the most probable diagnosis?

• A. Pituitary failure
• B. Ovarian failure
• C. Fresh pregnancy
• D. Uterine synechiae

Hint:

Normal FSH after a curettage points to the cavity, not the ovary or pituitary.

Answer 1

The Correct Option is D

Step 1: Note the trigger event. Amenorrhea that starts after a uterine procedure such as an abortion or dilatation and curettage points to intrauterine damage. Curettage can scar the endometrium and stick the uterine walls together, called Asherman syndrome (uterine synechiae).
Step 2: Use the hormone value. An FSH of 6 mIU/ml is normal. This is important because it rules out the conditions that change FSH.
Ovarian failure (option B) causes high FSH, usually >40 mIU/ml, because the ovary stops giving feedback. FSH of 6 is not high, so ovarian failure is excluded.
Pituitary failure (option A) causes low FSH, often very low, because the pituitary cannot make it. FSH of 6 is not low, so pituitary failure is excluded.
Step 3: Consider fresh pregnancy (option C). Pregnancy would cause amenorrhea, but the question frames this as a diagnostic puzzle after an abortion with a measured FSH; the classic teaching point here is the scarring problem, not a new pregnancy, and a simple beta-hCG would settle that. The examiner wants the post-curettage cause.
Step 4: With a normal FSH and a clear history of a uterine procedure, the ovary and pituitary are working but the endometrium or cavity is damaged. This is Asherman syndrome, the uterine synechiae. The answer is option D.