[42.11 I). This patient has two potential causes of amenorrhea: IUA caused by the uterine curettage and cervical stenosis due to the cervical conization. The biphasic basal body temperature chart suggests normal functioning of the hypothalamus-pituitary-ovarian axis. The crampy abdominal pain most likely is due to retrograde menstruation: thus, this is most likely due to a cervical process, cervical stenosis. Left untreated, this patient likely will develop severe endometriosis.

[42.2] A. It is not laparoscopy (which visualizes the intraperitoneal cavity) but hysteroscopy that is the best test. Curettage of a pregnant uterus predisposes to IUA.

|42.3| B. One of the methods of diagnosis of a uterine and/or cervical problem is the absence of menstrual bleeding with the use of cyclical hormonal therapy. If the endometrium has the capacity to respond to hormonal therapy and the cervix is patent, menstrual blood should be seen. With IUA. the endometrium is not responsive to hormonal therapy.

|42.4| C. With IUA, the hormonal status of the woman should be normal. Hot flushes connote ovarian failure, leading to decreased levels of estradiol.

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