24 year-old woman presents because she has not had menses for four months. She has had irregular periods since menarche at age 13. She has no medical history and is not taking any medications. She is thin (BMI 16) and has chronic anxiety. Her beta-hCG is <5 mIU/mL and her prolactin and TSH levels are normal. What is the next best diagnostic test to order

Based on the information, ask her about her diet. If she has been thin for a long time. My best guess is anorexia, or another eating disorder. She is obviously underweight and that most definitely leads to irregular periods. At times anorexia can even cause infertility. I would also ask her about her mental health. A lot of the times this can even be signs of mental illness such as depression.

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