N/P Gyne

Thank you for referring Sarah Johnson, a 32-year-old female, for assessment of irregular menstrual cycles and pelvic pain. Thank you also for the included information. Sarah has been experiencing irregular menstrual cycles for the past six months, with cycles ranging from 21 to 35 days. She reports moderate pelvic pain that has worsened over time, particularly during menstruation. Sarah has no other significant symptoms. She underwent a pelvic ultrasound, which showed a small ovarian cyst. She has tried over-the-counter pain relief with limited success and has not seen any specialists for this problem before. Sarah's last menstrual period was on October 15, 2024. Her menstrual periods occur every 28 to 35 days, last 5 days, and are heavy. She does not experience intermenstrual bleeding. She is sexually active and reports no pain during intercourse. She has had two pregnancies, both delivered vaginally. Her last pap smear was in January 2023, and it was normal. She uses oral contraceptive pills for birth control. Sarah otherwise has a history of hypothyroidism, managed with levothyroxine. She has had no surgeries. She takes levothyroxine 100 mcg daily and ibuprofen 400 mg as needed for pain. She is allergic to penicillin, which causes a rash. Sarah is married and works as a teacher. Her family history is significant for endometriosis in her mother. She does not smoke. On examination, she weighs 68 kg and is 165 cm tall, with a BMI of 24.9. Abdominal examination revealed mild tenderness in the lower quadrants, with no organomegaly or masses. Vulvar examination was normal. Bimanual examination showed tenderness in the adnexal regions. A speculum examination was performed and was unremarkable. No additional procedures were done. Other investigations include a complete blood count, which was normal. **Impression & Plan** Sarah is a 32-year-old female with irregular menstrual cycles and pelvic pain, likely due to an ovarian cyst. Differential diagnosis includes endometriosis and polycystic ovary syndrome. We plan to monitor the cyst with a follow-up ultrasound in three months. Conservative treatment options, including continued use of oral contraceptives and NSAIDs for pain management, were discussed. Surgical intervention was not recommended at this time. The risks and benefits of the current management plan were discussed, and Sarah agreed to proceed. Follow-up is planned in three months, and educational material on ovarian cysts was provided. **Short Summary** Sarah Johnson, a 32-year-old female, was assessed for irregular menstrual cycles and pelvic pain. An ovarian cyst was identified, and conservative management with follow-up was recommended.