In a premenopausal woman with irregular menses and hot flashes, which hormonal pattern is most likely?

• A. Increased FSH and LH with decreased estrogen
• B. Decreased FSH and LH with increased estrogen
• C. Increased prolactin
• D. Decreased GnRH

Answer: (A)

When estrogen production from the ovaries falls, the negative feedback on the pituitary decreases. In response, GnRH release becomes more pronounced and the pituitary increases its secretion of gonadotropins. FSH rises especially because inhibin from developing follicles declines, removing more suppression of FSH than of LH. The net effect is higher FSH and LH with low estrogen, which aligns with irregular menses and hot flashes in this setting. A pattern of decreased GnRH wouldn’t account for the elevated gonadotropins, and an isolated rise in prolactin isn’t the typical driver of these symptoms.