Question

A 23-year-old G0 comes to the clinic because she is interested in becoming pregnant. She is in good health; however, she has not had any menses for the last two years. She had menarche at age 15, had normal periods until three years ago, when she started having periods irregularly every three months until it stopped two years ago. She has no history of pelvic infections or abnormal Pap smears. She exercises every day by running and has run four marathons in the last three years. She is 5 feet 10 inches tall and weighs 115 pounds. Her examination including a pelvic exam is normal. Laboratory results show: Results Normal Values TSH 3.5 mIU/ml 0.5-4.0 mIU/ml Free T4 0.9 ng/dl 0.8-1.8 ng/dl Prolactin 10 ng/ml <20 ng/ml FSH 6 mIU/ml 5-25 mIU/ml LH 4 mIU/ml 5-25 mIU/ml BHCG 2 mIU/ml <5 mIU/ml What is the most appropriate next step in the management of this patient?

A. Check cortisol levels
B. Order a brain MRI
C. Obtain a pelvic ultrasound
D. Check testosterone levels
E. Check estrogen levels

Answer 1

For a 23-year-old female with amenorrhea seeking pregnancy, the next management step should be to check estrogen levels, as this may provide insights into her hypothalamic-pituitary-ovarian axis function.

Step-by-step explanation:

The most appropriate next step in the management of a 23-year-old female with amenorrhea who is interested in becoming pregnant would be to check estrogen levels.

Given that her body mass index (BMI) is low, this could be a case of hypothalamic amenorrhea, which is often associated with low body weight and excessive exercise.

The normal range laboratory values suggest thyroid disease or hyperprolactinemia are less likely. Therefore, checking her estrogen level is a logical next step, as it could provide more information on her hypothalamic-pituitary-ovarian axis function and help address the cause of her amenorrhea.