Approach to secondary amenorrhea Quiz: Ace Your Exams
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A 25-year-old nulligravid woman presents to the clinic with a 4-month history of amenorrhea. Her cycles had always been regular, coming once every 28 to 30 days; however, 8 months ago, her cycles became longer and irregular, coming every 30 to 45 days. She mentions that penetrative sex has become painful recently. Family history is notable for breast cancer in her grandmother at age 58 and the patient has a brother and uncle both with intellectual disability. Temperature is 36.5°C (97.8°F), pulse is 68/min, respirations are 14/min, blood pressure is 114/74 mm Hg, and body mass index is 22 kg/m2. Neurologic, skin, neck, thoracic, and abdominal examinations are unremarkable. On pelvic exam, there is a loss of vaginal rugae, otherwise, the cervix appears normal, the uterus and adnexa have normal contours and are non-tender to palpation. Lab results are shown in the table below. Which of the following is the most likely cause of this patient’s amenorrhea?
| Laboratory value | Result |
| Serum chemistry | |
| Follicle-stimulating hormone (FSH) | 45 IU/L |
| Estradiol (E2) | low |
| Thyroid-stimulating hormone (TSH) | 2.9 mU/L |
| Prolactin (PRL) | 13 ng/mL |
| Urine | |
| Human chorionic gonadotropin (HCG) | negative |
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