09-03-2008, 08:33 PM
A 39-year-old woman comes to the office because she has not had a menstrual period for the past 2 months. Before that time she was having regular monthly menstrual cycles lasting 28 days with a 4-day menses. Lately she has been feeling unusually cold and has been experiencing œon and off constipation. She has a history of migraines and had a laparoscopic left ovarian cystectomy 15 years ago. She is a divorced mother of a 10-year-old daughter and 8-year-old son. She works as a corporate lawyer and experiences a lot of stress. Physical examination shows puffy eyes, pale and dry skin, and diffuse alopecia. The remainder of the examination, including breast and pelvic examinations, is normal. Which of the following is the most appropriate next step in diagnosis?
A. Endometrial biopsy
B. Measurement of serum follicle-stimulating hormone level
C. Measurement of serum thyroid-stimulating hormone level
D. Measurement of urine human chorionic gonadotropin level
E. Pelvic computed tomography scan
A. Endometrial biopsy
B. Measurement of serum follicle-stimulating hormone level
C. Measurement of serum thyroid-stimulating hormone level
D. Measurement of urine human chorionic gonadotropin level
E. Pelvic computed tomography scan