Primary Amenorrhea in a 19-Year-Old Woman with Polycystic Ovary Syndrome and Grade II Obesity: A Case Report

Abstract

Primary amenorrhea requires systematic evaluation to identify abnormalities involving the reproductive tract, ovaries, hypothalamus, pituitary gland, or other endocrine conditions. Polycystic ovary syndrome (PCOS) is associated with ovulatory dysfunction, hyperandrogenism, hyperinsulinemia, insulin resistance, and obesity. Case Presentation: A 19-year-old woman presented to the Fertility, Endocrinology and Reproduction clinic of Dr. Mohammad Hoesin General Hospital, Palembang, with primary amenorrhea. She had never experienced menarche and reported increased fine hair growth on the face, abdomen, back, and lower extremities. Her weight was 81 kg, height 155 cm, and body mass index was 33.7 kg/m². Physical examination revealed hirsutism with a Ferriman–Gallwey score of 12. Laboratory evaluation showed elevated fasting insulin (34.2), testosterone (4.44 ng/mL), and increased LH relative to FSH, while prolactin, thyroid function, fasting glucose, and HbA1c were within the reported reference ranges. Pelvic ultrasonography showed a normal-sized anteflexed uterus and ovaries without abnormalities of the internal genital organs. Management included a progestin challenge and lifestyle intervention with gradual weight reduction, physical activity, and a low-carbohydrate, low-fat diet. The clinical and laboratory findings demonstrated hyperandrogenism associated with amenorrhea and obesity. The case highlights the importance of systematic evaluation through history, physical examination, hormonal assessment, and pelvic imaging. The findings were consistent with PCOS based on the Rotterdam criteria discussed in the source case. Comprehensive evaluation identified hyperandrogenism and metabolic abnormalities. Management focused on lifestyle modification and medical therapy, with attention to menstrual regulation, hyperandrogenic manifestations, metabolic risk, and future reproductive goals.