Complaints of An Irregular Menstrual Cycle

Jasmine, a 28 year old female, G0P0, presents to you with complaints of an irregular menstrual cycle. She states menarche was at 13 years old. Her menstrual cycle comes every 30 days, but over the past year her menstrual cycle has been more erratic. Her last menstrual cycle was 11 weeks ago today. She admits that she sexually active, with one partner, and uses male condoms as their form of contraception. She denies ever being on hormonal contraception. She denies alcohol, tobacco or drug use. She denies exercising.

On physical examination, you notice that she has gained 25 pounds in the past 18 months. Her BMI is now 32. Her physical examination is otherwise normal, except for fine hair growth on her face and a velvety thickening of the skin on her neck. Her pelvic examination reveals normal external genitalia, no vaginal or cervical discharge, negative cervical motion tenderness and a retroverted uterus, without uterine or adnexal masses.

What is your primary diagnosis?

List 3 differential diagnoses for the above case.

What is the first laboratory test you should order for Jasmine?
What treatment do you recommend for Jasmine?

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