Aimee, a 23 year old university student, comes to see you because she hasn’t had a period for 5 months. She has only had 3 periods since she came off the OCP 10 months ago. She originally started taking the pill (Juliet-35ED) at age 15 for acne, and then continued it for contraception. She stopped it because she came out of a relationship and wanted a break from medication. Her acne is also a bit worse than it was and she wants to discuss treatment options. She’s not too keen to go back on the pill because her mother had problems falling pregnant after taking the pill for years, and Aimee is worried the same thing might happen to her.
PMH: Nil significant
Gynae Hx: Menses age 13. No pregnancies. Last pap 3 years ago.
Family Hx: Type 2 diabetes (maternal grandmother), IHD (uncle).
Oe: BP 115/70, Pulse 70, BMI 23
Mild acne on forehead and chin.
Abdo – Soft non-tender
Spec – NAD. Pap smear taken.
1. What is the most likely diagnosis and what do you need to rule out?
2. What investigations would you perform?
3. What is your management approach?
Please comment below. My suggestions to follow in the next couple of days.