A 31-year-old woman, a competitive distance runner, comes to your office because she has had no menses for 8 months. Her menarche was at age 13, with regular cycles until a year ago when she increased her training to about 100 km/week and began a restrictive diet. She also reports constipation. She takes no medications, has no allergies, and is sexually active with a male partner who uses condoms. On examination, her BMI is 17.4 kg/m2 and the pelvic examination is normal. Investigations: urine pregnancy test negative; TSH 2.1 mIU/L (0.4-4.0); prolactin 11 ug/L (<25); FSH 3.2 IU/L (3-10); LH 1.6 IU/L (2-12); estradiol 62 pmol/L (100-600). Bone mineral density shows a lumbar spine Z-score of -1.9.
| Heart rate | 52/min |
| Respiratory rate | 14/min |
| Temperature | 36.4 °C |
| O2 saturation | 99%, room air |
| Blood pressure | 98/62 mm Hg |
Question 1 of 12
Which of the following are the most appropriate initial management steps?
Select 2. (0 / 2 selected)
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