A 27-year-old woman presents to the office complaining of hot flashes and cessation of menses since stopping her oral contraceptives six months ago. The hot flashes occur several times a day without perspiration or other symptoms, and they disturb her sleep. The patient had normal developmental milestones and menarche at age 12 years. She started taking oral contraceptives five years later for irregular menses and contraception but, as mentioned, stopped them recently because she got married and desired fertility.
Since then, her only other symptoms have been fatigue and a swelling sensation in her neck that sometimes "chokes" her at night when she sleeps on her back. The patient is on no medications, and no contributory factors are found in her previous or family medical history or in the review of systems. She works in the insurance field, has a normal diet, and engages in normal…
