SECONDARY AMENORRHEA

A   32-year-old woman   states  that    her last    menstrual   period  was one year

ago.    She started menses  at  age 12  and was irregular   for the first   couple  of

years,  but since   age 14  or  15  she has menstruated every   28–29   days.   She

has not been    pregnant    and is  concerned   about   the amenorrhea. She has not

been    sexually    active  and has not used    contraception.  She has no  other

significant personal    or  family  history.    Physical    examination,    including   a

pelvic  exam,   is  normal.