MEDizzy - A 17-year-old G0 girl with dysmenorrhea secondary to

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USMLE I Test Block III

A 17-year-old G0 girl with dysmenorrhea secondary to moderate endometriosis presents with her mother to the gynecologist for follow up. She was started on a combination oral contraceptive pill 10 months ago but experienced only mild relief of her symptoms. She returns to the gynecologist’s office today to discuss the next line of therapy. What is the most appropriate next step in treating her endometriosis?

ExplanationThe correct answer is C. Leuprolide is a gonadotropin-releasing hormone (GnRH) analog that is commonly used to help control the symptoms of endometriosis. Release of pituitary follicle-stimulating hormone (FSH) and luteinizing hormone (LH) requires pulsatile secretion of GnRH. Constant pituitary stimulation with leuprolide, or other GnRH analogs, inhibits FSH/LH secretion, preventing normal folliculogenesis and ovulation. Impaired follicle growth and maturation causes a decreased level of circulating estrogen, which in turn decreases the proliferation of endometrial tissue and minimizes the pain associated with ectopic endometrium. Leuprolide is an appropriate medical treatment choice for endometriosis that has failed treatment of combination OCPs.