25-year-old woman, gravida 1 para 1, comes to the office for evaluation of amenorrhea. Twelve weeks ago, the patient vaginally
delivered a healthy girl The delivery was complicated by a retained placenta and postpartum hemorrhage that required manual
extraction of the placenta and a blood transfusion. The patient is concerned as she has had no menstrual period since the delivery.
She is breastfeeding exclusively and has not resumed sexual intercourse. She has no pelvic pain or vaginal discharge. Blood
pressure is 100/70 mm Hg and pulse is 60/min. Examination shows a small uterus with no cervical motion tenderness and no blood in
the vaginal vault. Which of the following is the most likely mechanism for this patient’s amenorrhea?
- Q A Absent LH and FSH production
- Q B. Estrogen stimulation of endometrial proliferation
- Q C. Impedance of menstrual flow by intrauterine adhesions
- Q D. Prolactin inhibition on gonadotropin-releasing hormone release
- Q E. Suppression of ovulation by beta-human chorionic gonadotropin
0 voters