What is the most likely cause of menstrual disturbance in a 21-year-old woman with a history of amenorrhoea after stopping the contraceptive pill?

In this scenario, the most likely cause of menstrual disturbance in a 21-year-old woman who has experienced amenorrhea after stopping the contraceptive pill is hypothalamic amenorrhea.

When the contraceptive pill is stopped, the body needs to readjust and resume natural hormonal cycles, which can sometimes lead to a temporary disruption in the hypothalamic-pituitary-ovarian axis. This axis is responsible for regulating the menstrual cycle. Factors such as significant stress, excessive exercise, or low body weight can suppress hypothalamic function, leading to a lack of gonadotropin-releasing hormone (GnRH) and consequently amenorrhea.

In the context of the given scenario, hypothalamic amenorrhea would not only explain the absence of menstruation following the discontinuation of hormonal contraception but also highlight the idea that the amenorrhea is likely due to disruptions in the hormonal regulation influenced by the changes in lifestyle or psychological factors.

Other conditions like macroprolactinoma and polycystic ovary syndrome are less likely to be the primary reasons here, especially in the absence of symptoms suggestive of hyperprolactinemia (such as galactorrhea or headaches in the case of a macropro