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Old 04-01-2015
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Default Progestin Withdrawal Test

How to differentiate between anovulatory bleeding and progestin withdrawl bleeding? For a patient who is unable to conceive, but have irregular bleeding, I know you check prolactin and TSH levels first but if they're normal, you then are supposed to do the progestin withdrawal test to see whether they're ovulating. If a patient bleeds then the problem is anovulation, but hence my question. How do you know if the bleeding is from progestin withdrawal and not estrogen breakthrough bleeding?
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Old 04-01-2015
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First, breakthrough bleeding is associated with the use OCPs and that's the only way it will be asked in USMLE.

Second, there's a big difference between the amount of blood in each, it's usually spotting in "breakthrough" and actually menstrual blood (we're talking 60ml of blood) in the progestin withdrawal test.

Third, USMLE is big on using distractors but NOT on confusing you. If they said a patient on OCPs had MID-cycle spotting that's breakthrough bleeding. If they said a patient without menstrual cycles (as progesterone is deficient) and you just gave them progesterone then it's just bleeding from the progesterone withdrawal test.

Can you note the big difference between both in term of case scenario?
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Old 04-02-2015
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Thank you! I got it
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