A 28-year-old female presents to her primary care doctor for concern of increased weight gain and amenorrhea. She has had irregular menses since menarche at 11 years of age. She has been intermittently on oral contraceptive pills (OCPs) in the past which regularized her menses, but she hasn’t taken an OCP in the past 2 years. She was overweight as a teenager but has had a recent abrupt weight gain of 30 lbs in the past year. She has tried to lose weight with a low-fat diet and exercise in the past and lost 10 lbs 2 years ago, which she subsequently regained. Although her menses were irregular in the past, she would have 3–4 cycles/year, but now her last menstrual period was 6 months ago. Home pregnancy test is negative. She has always had facial hair which she has managed cosmetically by waxing, but she feels this has now become excessive and darker over the past year. She has a family history of type 2 diabetes in her mother. She is not trying to conceive but she is anxious about her fertility in the future. Her physical examination is significant for a body mass index (BMI) of 32 kg/m2, waist circumference 95 cm, BP 130/80, moderate hirsutism and acne, and acanthosis nigricans around the neck. She has no clinical stigmata suggestive of Cushing’s syndrome. Laboratory tests reveal a total testosterone level of 60 ng/dl (reference range, 14–53 ng/dl), calculated free testosterone level of 15.3 pg/ml per milliliter (reference range, 0.6–6.8 pg per milliliter), TSH 3.5 μIU/ml, FBG 102 mg/dl, and HbA1c 5.7%.
KeywordsPolycystic ovary syndrome Amenorrhea Weight gain Oligomenorrhea Hyperandrogenism
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