Female sexual physiologyDownloads

A 17-year-old girl presents to her pediatrician for a wellness visit. She currently feels well but is concerned that she has not experienced menarche. She reports to recently developing headaches and describes them as pulsating, occurring on the left side of her head, associated with nausea, and relieved by ibuprofen. She is part of the school’s rugby team and competitively lifts weights. She is currently sexually active and uses condoms infrequently. She denies using any forms of contraception or taking any medications. Her temperature is 98.6°F (37°C), blood pressure is 137/90 mmHg, pulse is 98/min, and respirations are 17/min. On physical exam, she has normal breast development and pubic hair is present. A pelvic exam is performed. A urine hCG test is negative. Which of the following is the best next step in management?

A 51-year-old woman presents to the primary care clinic complaining of trouble sleeping. She reports that she has episodes of "overheating" and "sweating" during the day and at night. The nightly episodes keep her from staying asleep. She also explains how embarrassing it is when she suddenly becomes hot and flushed during work meetings. The patient becomes visibly upset and states that she is worried about her marriage as well. She says she has been fighting with her husband about not going out because she is "too tired." They have not been able to have sex the past several months because "it hurts." Labs are drawn, as shown below: Follicle stimulating hormone (FSH): 62 mIU/mL Estradiol: 34 pg/mL Progesterone: 0.1 ng/mL Luteinizing hormone (LH): 46 mIU/mL Free testosterone: 2.1 ng/dL Which of the following contributes most to the production of estrogen in this patient?