26 year old female

CC: amenorrhea for 8 months.

HPI:
Medically free, call complaining from amenorrhea for 8 months. There is no hirsutism, or acne, not use any
medications including OCPs, no headaches or significant visual problem, no N/V, not breastfeeding and no
nipple discharge, no palpitations, no difficult weight loss, temperature intolerance, diarrhea or constipation.
No history of excessive exercise or poor diet.
Usually she is anger with mood swings.
OB/GYN history: menarche at age of 12 , her menstruation was regular. P2+0. Her first baby delivered by CS
6 years back, young one is 18 months old NVD
She take Primolut N 1 tab TID for 10 days and today is day 3 since discontinued

Past medical and surgical : thalassemia minor ( as pt said) , cholecystectomy, CS

Social: married, not smoker

Family history: unremarkable her mother is 54 year and she is still had a period, she had 4 sisters with no
gynecological problem
• CBC: HB 10.4
MCV 61.9
MCH 18.3
MCHC: 29.5
RDW: 8.6
NL WBCs and Plt
• TSH: 2.37
 Amenorrhea
secondar
Primary
y
characterized as the cessation of
defined as the failure to reach previously regular menses for
menarche three months or previously
irregular menses for six months

Evaluation should be undertaken

if there is no pubertal
development by 13 years of age,
if menarche has not occurred
five years after initial breast
development, or if the patient is
15 years or older