Endo Case Challenge: Amenorrhea for Months, Mood Swings, Weight Gain in a 38-Year-Old Woman

Benjamin Scott Harris, MD, MPH; Thomas Michael Price, MD


September 13, 2022

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.


A healthy 38-year-old woman (gravida 0) presents for an infertility evaluation after 14 months of attempting to conceive without success. She reports new-onset amenorrhea 4 months before presentation, despite previously having regular menstrual cycles. She denies any physical symptoms but has noticed easy bruising and recently has had worsening emotional lability. During the past year, she has gained 30 lb (13.6 kg). She has no history of fertility treatment or evaluation.

The patient takes vitamin D, a multivitamin, folic acid, and vitamin B12 supplements. She has no past surgical history. Her Papanicolaou test is up to date, and she has no history of dysplasia. She has never smoked and consumes approximately three alcoholic beverages per month. Her family history is negative for breast, colon, and gynecologic cancer. Her brother has hypothyroidism, and her sister has thyroid disease. She has no history of birth defects, genetic diseases, venous thromboembolism, endometriosis, or fibroids.

Her partner is 35 years old and has a history of kidney stones. He takes no medications and smokes three or four cigarettes daily. He has no history of sexual dysfunction or family history of birth defects or genetic diseases. He has never had a semen analysis.


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