{"ops":[{"insert":"A 28-year-old woman presents with amenorrhea for six months, along with intermittent hot flashes and night sweats. She first assumed that she was pregnant, but urine dipstick testing four months ago was negative. Her menarche was at 12 years of age. Her cycles were regular during her teenage years and early twenties, but became irregular afterwards. Her medical and surgical histories are unremarkable. Her mother attained menopause at the age of 36; this was not investigated. She has been married for two years now and is looking forward to starting a family.\n\nPregnancy dipstick testing is negative. A full blood count, fasting plasma glucose, and renal and liver profiles are normal. Endocrine assessment is significant for a serum FSH of 103 IU\/mL (normal: 3.5-12.5), LH of 92 IU\/mL (normal: 2.4-12.6), and estradiol (E2) of 12 pg\/mL (normal: 12.5-166). T4, TSH, and prolactin levels are within normal limits.\n\n"},{"insert":{"image":"\/storage\/case-images\/pd\/PD-G-038_en.png"}},{"insert":"\n"}]}
{"ops":[{"insert":"Genetic studies are positive for an expanded allele (pre-mutation) of the FMR1 gene.\n"}]}
Pelvic ultrasound
{"ops":[{"insert":"Pelvic ultrasound reveals a uterine volume of 161 cm3, with an endometrial thickness of 0.5 cm. The right ovarian volume is 2.17 cm3, and left ovarian volume is 1.28 cm3. A few follicles are visualized in both ovaries.\n"}]}
DXA Scan
{"ops":[{"insert":"Dual-energy X-ray absorptiometry (DXA) shows a T score of -2.2 in the L1-L4 lumbar spine and -1.8 in the neck of the femur.\n\nReference ranges\n-----------------------\nNormal: +1.0 to -1.0\nOsteopenia: -1.0 to -2.5\nOsteoporosis: -2.5 to -3.0\nSevere osteoporosis: less than -3.0\n"}]}
