A 30-year-old obese patient presents with irregular menses and reports inability to become pregnant

She should take oral contraceptive pills (OCPs) or cyclic progesterone to protect her endometrium

The patient described has polycystic ovarian syndrome (PCOS) based on the description of menstrual irregularity due to oligoovulation and clinical evidence of hyperandrogenism. The other causes can be excluded by the noted laboratory studies. OCPs have been the mainstay of long-term management of PCOS and offer benefit through the suppression of ovarian androgens, increased circulating sex hormone-binding globulin, and endometrial protection. In a woman who desires contraception, OCPs would be the best treatment option. However, in this patient, who does not desire contraception, cyclic progesterone would also be a reasonable treatment option to protect the endometrium, although it would not provide the same antiandrogen benefits as combination OCPs. Regulation of the menstrual cycle is an added benefit of using OCPs; however, it is not the primary reason to initiate this treatment strategy. Although this patient may need ovulation induction with clomiphene or other agents to conceive, she is not interested in getting pregnant at the present time and fertility treatments are not currently indicated.

References:

Welt CK, Barbieri RL. Etiology, diagnosis, and treatment of secondary amenorrhea. In: Basow DS, ed. UpToDate. Waltham, MA: Wolters Kluwer Health; 2012. http://www.uptodate.com/contents/etiology-diagnosis-and-treatment-of-secondary-amenorrhea . Accessed August 7, 2012.

Polycystic ovary syndrome. In: American College of Obstetricians and Gynecologists. ACOG 2008 Compendium of Selected Publications. Volume 2. Washington, DC: ACOG Press; 2008: 1121-1130.