Question

A 33-year-old nulliparous woman presents with amenorrhea for the past 12 months. She also reports a recent onset of dyspareunia, causing her to feel anxious about having intercourse. She had menarche at age 15. Her cycles were normal until two years ago when she began skipping menses. She is otherwise in good health. She is 5 feet 4 inches tall and weighs 130 pounds. Her physical examination is completely normal. TSH and prolactin levels are normal. Urine pregnancy test is negative. What is the most likely cause of this patient's amenorrhea?

A. Psychogenic
B. Genital tract outflow obstruction
C. Asherman's syndrome
D. Premature ovarian failure
E. Pituitary adenoma

Answer 1

The most likely cause of the 33-year-old woman's amenorrhea is premature ovarian failure, given her age, the absence of physical findings, and normal TSH and prolactin levels.

Step-by-step explanation:

The 33-year-old nulliparous woman with amenorrhea for the past 12 months is likely experiencing premature ovarian failure (Option D). The reported symptoms, including skipping menses and recent onset of dyspareunia, along with her age and the absence of other physical findings or abnormal hormone levels such as TSH and prolactin, suggest this diagnosis. Premature ovarian failure is characterized by the cessation of menstrual cycles before the age of 40 due to the loss of ovarian function. In comparison, a pituitary adenoma would likely cause abnormal TSH or prolactin levels, which are not present in this case.