Menstrual Irregularity

HISTORY:

Irregular periods for ‍ ‍hoursdays

Cycle: ‍ days

Onset: ‍gradualsuddensince menarche, occurred after ‍ ‍weight gain

Pattern: ‍persistentintermittent

Menstrual flow: ‍lightnormalheavy, ‍with smallwith largewithout clots

‍pelvic pain

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍weight gain, ‍ ‍lbskg over ‍ ‍weeksmonths

‍weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional

‍hot flashes

‍night sweats

‍vaginal dryness

‍fertility issues

‍irritability

‍fatigue

‍hair loss



Gynecological history:

Menarche: ‍ years old

Contraception: ‍yesno ‍oral contraceptives, ‍compliantfrequently misses pills

Condom use: ‍alwayssometimesnever

G‍01234 P‍01234 A‍01234

Menopausal status: ‍premenopausalperimenopausalmenopausal





EXAM:

General appearance: ‍well-appearing

Breasts: -R: ‍normal, -L: ‍normal

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Pelvic: vulva ‍normal, vagina ‍normal, cervix ‍normal, uterus ‍normal, adnexa ‍normal, ‍no cervical motion tenderness



ASSESSMENT:

‍Polycystic ovary syndrome ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍TSH, ‍prolactin, ‍FSH, ‍LH, ‍estradiol, ‍progesterone, ‍β-hCG, ‍testosterone on day 3 of cycle, ‍DHEAS, ‍17-OH progesterone, ‍cortisol

- Pelvic ultrasound

- Pelvic MRI

- Progestin challenge test: Medroxyprogesterone 10mg po for 10 days (if bleeding occurs, anovulation is confirmed)

- Endometrial biopsy

- Lifestyle modifications: ‍weigh loss, ‍avoid thinness, ‍healthy diet, ‍regular exercise, ‍avoid overtraining, ‍stress management

- ‍Oral contraceptives

- ‍Progestin therapy

- ‍Metformin

- Referral to gynecologist

- Referral to endocrinologist

- Follow-up in ‍ ‍weeksmonths

- Return if menstrual irregularity persists, if new symptoms develop such as heavy bleeding or pelvic pain, or if symptoms do not improve with treatment

- Go to ER if severe abdominal pain or heavy bleeding occurs