Diagnostic evaluation of progesterone. Challenge test in amenorrheic patients

Forty-one amenorrheic patients were grouped on the basis of presence or absence of withdrawal uterine bleeding following the intramuscular administration of progesterone. Ovarian volume, ovarian morphology with particular reference to presence or absence of follicles and state of follicular development, and steroidogenic function were investigated in each group. Most of amenorrheic patients with progesterone-induced uterine bleeding had relatively large ovaries with follicles of high developmental stage (tertiary-Graafian follicle) and responded to exogenously administered HMG and HCG with a rise in the 24-hour urinary excretion of total estrogens. In contrast, most of amenorrheic patients without progesterone-induced uterine bleeding had relatively small ovaries without follicles or with follicles of low developmental stage (primordial-secondary follicle) and did not respond to exogenous HMG and HCG. The results of the present study suggest that presence or absence of progesterone-induced uterine bleeding is closely correlated with the volume, morphology and steroidogenic function of the ovary in amenornorrheic patients. Thus, pathologic amenorrhea could be divided into two groups by utilizing the progesterone challenge test and this clinical categorization might be useful for the diagnosis and treatment of amenorrheic patients.