Progesterone Challenge

[boardsbandit524]

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I know this test is used to distinguish DUB Anovulatory vs DUB ovulatory but I'm confused at to how it differentiates the two:

With anovulatory DUB you have too much estrogen and thus with the added progesterone from the challenge you do menstruate? Is this correct?

If that is the case what happens in an ovulatory DUB? So confused....

 

[doctorFred]

I know this test is used to distinguish DUB Anovulatory vs DUB ovulatory but I'm confused at to how it differentiates the two:

With anovulatory DUB you have too much estrogen and thus with the added progesterone from the challenge you do menstruate? Is this correct?

If that is the case what happens in an ovulatory DUB? So confused....

if there is no withdrawal bleed after a progestin challenge, it's an indication that the deficiency is "further up the tract", so to speak. the ovaries are not producing sufficient estrogen, either as a primary deficit, secondary deficit (fsh + lh), or tertiary deficit (gnrh.)

if a withdrawal bleed occurs, it means that the ovaries and uterus are connected and functioning properly, the vagina is patent, and a sufficient amount of estrogen is being produced (which generally indicates proper functioning of lsh, fh and gnrh.)

i find it more helpful to think of anovulatory cycles not as "too much estrogen", but rather, "not enough progesterone", hence the reason for the progestin challenge. "too much estrogen" should be the link you draw to endometriosis.