In an amenorrheic patient with suspected estrogen deficiency, withdrawal of progesterone therapy would most likely result in which of the following?

• A. Menses occur after withdrawal
• B. Prolonged heavy menses
• C. No menses
• D. Spotting

Answer: (C)

Progesterone withdrawal testing checks whether the endometrium was adequately primed by estrogen. If estrogen levels are sufficient, the endometrium proliferates and will shed after progesterone is stopped, producing a withdrawal bleed. In estrogen deficiency, the endometrium hasn’t built up enough, so stopping progesterone doesn’t trigger shedding, leading to no menses. Therefore, the most likely outcome is no menses after withdrawal. If a withdrawal bleed occurred, that would suggest some estrogen priming was present, arguing against estrogen deficiency.