Abnormalities in the systems of this compartment are uncommon. There is a deficiency in GnRH pulsatile secretion. If positive, treat your patient as a pregnant patient. If pregnancy test is negative, draw a TSH and Prolactin Level, do a Progesterone Challenge Test. If TSH elevated or depressed, treat thyroid disorder Progesterone challenge test.
Positive test is any vaginal bleeding.
Bleeding usually occurs in 2-7 days. A withdrawal bleed indicates a functional outflow tract and a uterus primed with endogenous estrogen. The progesterone challenge may repeated once if no bleeding. Drug regimen for progesterone replacement is discussed below under medication heading. No withdrawal bleed after progesterone challenge.