Advanced Fertility Center of Chicago ivf

Progesterone Withdrawal Test - Progesterone Challenge A Diagnostic Test for Secondary Amenorrhea

  • The progesterone challenge test is is also referred to as a progestin challenge
  • It is done by givng a progestin medication and seeing if this induces a menstrual period
  • This same protocol of giving a progestin is often used to induce a period in women with irregular periods:
    • if she has not had a period for a while
    • if she skipped a period

How the Test Works

The progesterone challenge test is done by giving oral medroxyprogesterone acetate (Provera) 10 mg daily for 5-10 days or one intramuscular injection of 100-200 mg of progesterone in oil.

A positive response is any bleeding more than light spotting that occurs within 2 weeks after the progestin is given. This bleeding will usually occur 2-7 days after the progestin is finished.

Withdrawal bleeding will usually be seen if the patient's estradiol level has been over about 40 pg/ml.

Possible Outcomes of the Test

  • If the patient experiences bleeding after the progestin she has estrogen present but is not ovulating (anovulation).
  • If no withdrawal bleeding occurs, either the patient has very low estrogen levels or there is a problem with the outflow tract such as uterine synechiae (adhesions) or cervical stenosis (scarring).

Women with Withdrawal Bleeding

  • The test has demonstrated that she builds up a lining in the uterus.
  • She bleeds after progesterone is withdrawn - showing that it is the lack of ovulation that is causing her not to have periods.

Possible Diagnoses for Women with Withdrawal Bleeding

Women without Withdrawal Bleeding

Possible Diagnosis

  • Hypothalamic hypoestrogenism (low estrogen levels)
  • Compromised outflow tract - either Asherman's syndrome (adhesions) or cervical stenosis (scarring)
  • Premature ovarian failure

The Next Step: Give Estrogen and Progestin to Distinguish Between Hypoestrogenism or an Outflow Tract Obstruction (Asherman's Syndrome or Cervical Stenosis)

Give estrogen to ensure endometrial proliferation, followed by a progestin to induce withdrawal bleeding. A course of 2.5 mg of Premarin for 21 days including 10 mg of Provera on days 17-21 should be adequate.

  • If bleeding occurs, amenorrhea is due to hypoestrogenism (hypothalamic amenorrhea or premature ovarian failure).
  • If bleeding does not occur, then most likely it is an outflow tract obstruction - either Asherman's syndrome or cervical stenosis.

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I am so grateful for Advanced Fertility Center. I just had my son Leland. I want to thank Dr. Catenacci and all of the nurses that helped us. Especially Ashley in the Crystal Lake office. You made this process easier by being supportive and positive. Thank you very much!


Dr. Sherban and his staff are the most amazing, compassionate, and supportive people. After almost 5 years of trying to conceive, going through numerous tests and meeting with another clinic closer to home, who told me my chances even with IVF were still very low, a good friend recommended advanced fertility center of Chicago. Best decision we ever made! We now have 2 amazing children who are now 5 and 3 years old! I cannot stress enough how amazing this staff is, they make you feel like family!


Our experience was amazing with Dr. Cantanucci and all of the nurses (especially Ashley). After ttc for 4 years and at 41 years of age, we became pregnant after 1 round of IVF, and had our beautiful boy this past October. Can't thank them enough!


2/7/15 our son was born all thanks to the assistance of Dr. Sherbahn and his staff. Everyone was so helpful and here for all our questions, worries, etc. They want this for you just as much as you want this for you! Handled with pure professionalism and care from the very start! Thank you advanced fertility!