QuestionSBA
QuestionChoice
Serum FSH could be taken if pregnancy is ruled out and perimenopause is suspected, in which a marked increase in FSH levels would be seen. In this vignette, the patient describes symptoms that could be seen in both pregnancy and menopause, such as weight gain, night sweats and mood changes. Therefore, the initial step is to first rule out pregnancy with a urinary β-hCG test.
10025426
b
Serum FSH
QuestionChoice
Prolactin levels are more commonly assessed when there is a suspicion of hyperprolactinemia as a cause of amenorrhea. This condition can lead to irregular menstrual cycles and can sometimes present with other symptoms, but it is not as time-sensitive as ruling out pregnancy. Therefore, the initial step is to rule out pregnancy with a urinary β-hCG test.
10025428
d
Serum prolactin
QuestionChoice
Thyroid function tests can be considered, as a thyroid imbalance can cause menstrual irregularities. However, the combination of symptoms described, including oligomenorrhoea and weight gain, should prompt us to consider the possibility of pregnancy, especially given the patient's age and the fact that she is sexually active. Therefore, the initial step is to rule out pregnancy with a urinary β-hCG test.
10025429
e
Thyroid function tests
QuestionChoice
Serum oestrogen levels is not the initial investigation of choice because they do not directly address the primary concern of missed menstruation and the potential for pregnancy. Once pregnancy is ruled out, further evaluation including assessing hormonal levels, can be considered to investigate the underlying cause of secondary amenorrhea and associated symptoms. Therefore, the initial step is to rule out pregnancy with a urinary β-hCG test.
10025427
c
Serum oestrogen
QuestionChoice
This is the correct answer. Remember that it is essential to rule out pregnancy as a potential cause of amenorrhoea in women who are sexually active and are potentially at childbearing age. A urinary β-hCG test can quickly and definitively determine whether the patient is pregnant. When an embryo attaches to the uterine lining, it begins to produce hCG. In a healthy pregnancy, hCG levels rise rapidly in the early weeks.
10025425
a
Urinary β-hCG
Concept
Chapter
2693
5840
Secondary amenorrhoea
Topic
176
Gynaecology
17483
A 44 year old woman is concerned about the recent changes in her menstrual cycle. She has been experiencing regular monthly periods throughout her life but has not had a menstrual period for the past 2-3 months. She reports weight gain and occasional night sweats. Her husband adds that she sometimes becomes more irritable than usual. Her exercise routine has remained consistent with her usual activity level. She is sexually active, and takes no regular medications.

A physical examination is unremarkable.

What is the best initial investigation?
a