AccessMedicine's Case of the Week: Amenorrhea

From: Vanderbilt Internal Medicine and Pediatric Curriculum
AccessMedicine's Case of the Week: Amenorrhea


An 18-year-old G0 female comes in to see you for 4 months of amenorrhea. She is sexually active in a monogamous relationship and is not using condoms or other forms of birth control. She had menarche at age 13 and has had regular periods until about one year ago. For the last year, her periods have become more irregular with an average of 2 months between cycles. Social history and review of systems is otherwise negative. She has a family history of type 2 diabetes mellitus (DM). On exam, she is a moderately obese with Tanner stage 5 breasts and pubic hair. In addition, she has moderate cystic facial acne and some acanthosis on the nape of her neck. She has a normal pelvic exam with no clitoromegaly. The rest of her physical exam is otherwise normal. The patient has a normal urinalysis, and a urine pregnancy test is negative.


1. What is on your differential diagnosis and which laboratory tests would you like to order?
2. Free testosterone level is elevated, and pelvic ultrasound shows polycystic ovaries. How would you manage this patient?

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