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21-Year-Old Woman With Menstrual Irregularity, 1 Year Later

Jennifer Daley, MD; Thomas L. Delbanco, MD; Erin E. Hartman, MS
JAMA. 1997;278(20):1699. doi:10.1001/jama.1997.03550200075035.
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In December 1996 at obstetrics and gynecology grand rounds, Dr Ann Davis discussed the approach to evaluating irregular menses in a young woman with previously normal cycles. Ms K, a 21-year-old college student, had experienced difficulty with her menses for 1 year, first bleeding continuously, then ceasing her menses altogether. A progestational challenge did not induce withdrawal bleeding.

Dr Davis explained that many factors could contribute to abnormal cycling, such as several endocrinopathies, hypothalamic disorders, including dietary practices and body fat, exercise, and stress. She recommended that Ms K take an oral contraceptive to regulate hormone levels and induce monthly bleeding.

We asked the patient and her physician to comment on the year that has passed.

Ms K, THE PATIENT:  I didn't get my period still after the conference. So, a few months ago, I went to another hospital. They gave me the same medicine [Provera], and I got my


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