April 23, 1997

A 21-Year-Old Woman With Menstrual Irregularity

Author Affiliations

From the Department of Obstetrics and Gynecology and Reproductive Biology, Beth Israel Deaconess Medical Center, and Children's Hospital, Boston, Mass.

JAMA. 1997;277(16):1308-1314. doi:10.1001/jama.1997.03540400058032

Dr Daley:  Ms K is a 21-year-old single college student who has had difficulty with her menses for a year. She moved to this country in late 1995 to attend college. She studies education and lives with a friend in Boston. She has commercial indemnity insurance.Ms K experienced menarche at the age of 12 years and had regular periods every month lasting about 4 days. Mild cramps accompanied her menses, and she had bloating and breast tenderness prior to them. She has never been on birth control pills and has never been pregnant. Before coming to Boston, she was sexually active, used condoms, and received 2 shots (she does not remember the medication) for birth control at 3-month intervals, with the most recent injection in April or May 1995. She menstruated normally in July through October, but then began bleeding continuously in November 1995. Bleeding varied from heavy to