Integrated Problems Radiology: Amenorrhea

A 31 year old G2P2 presents to her primary care doctor because she has not had her period for the past 3 months.

She delivered her second child 10 months ago and states that her menses returned 2 months postpartum. She denies having a history of changes in her menstrual cycle. She reports that she is sexually active with her husband and when asked what she is using for birth control, she reports that “I am breastfeeding and I can’t get pregnant while doing that.” Of note, she stopped breast feeding one month ago. + intermittent headache x 3 months +”sometimes feels shaky” +weight loss (15 pounds in 6 months-attributed by patient to breast feeding and exercising and losing “the baby weight”, +sweating (“but I am running around all of the time so it’s just because I’m so busy”)

For each case, consider the following:

1. What imaging study (if any) would you order?

2. What clinical information would you give to the radiologist who will be doing the study?

3. Do you need to discuss anything with the radiologist before ordering the exam?