| Course | NU680 Gynecological, Reproductive, and Sexual Health |
|---|---|
| Unit | Unit 2 |
| Paper type | Amenorrhea workup paper |
| Length | About 1,220 words, 7 pages double-spaced |
| Format | APA 7 student paper |
| School | Purdue University Global |
| Program | MSN |
| Updated | October 2026 |
Free sample paper for NU680 Unit 2
Six Months Without a Period at Thirty-Three: A Unit 2 Amenorrhea Workup That Ends at Primary Ovarian Insufficiency
[Student Name]
Purdue University Global
NU680: Gynecological, Reproductive, and Sexual Health
Unit 2 Amenorrhea Workup Paper
[Instructor Name]
[Date]
The patient is composite; her values are illustrative; the sources cited are real.
The Presentation
Ms. Reyes is 33, married, and works from home as a graphic designer. Her menarche was at 13 and her cycles ran 27 to 30 days until about eight months ago, when they lengthened, then stopped. Her last period was six months before this visit. She reports waking drenched in sweat two or three nights a week, a feeling of heat rising up her chest during the day, and vaginal dryness that has made intercourse uncomfortable. She has not changed her weight, diet or exercise, and she describes her stress as ordinary. She takes no medications, has never had chemotherapy or pelvic radiation, and has no history of pelvic surgery. Her mother reached menopause at 46. A maternal uncle has an intellectual disability that the family has never had evaluated.
On examination her body mass index is 23, her blood pressure is 116/72, and her thyroid is not enlarged. There is no hirsutism, acne or galactorrhea. The vaginal mucosa is pale and thin for her age. A urine pregnancy test in the office is negative.
The Differential
Secondary amenorrhea, the absence of periods for three months in someone who previously had regular cycles, has four broad sources: pregnancy, the hypothalamus and pituitary, the ovary, and the uterine outflow tract. Pregnancy is excluded by the office test. Functional hypothalamic amenorrhea, caused by low energy availability, heavy exercise or stress, is the commonest cause in her age group, but her stable weight, unchanged exercise and night sweats argue against it, and the Endocrine Society guideline describes that condition as a diagnosis made after other causes are excluded (Gordon et al., 2017). High prolactin and thyroid disease each disturb ovulation and are easy to test. Polycystic ovary syndrome usually produces long, irregular cycles from adolescence with signs of androgen excess, which she lacks. Intrauterine scarring is possible only after uterine surgery or infection, and she has had neither. That leaves ovarian failure, which her vasomotor symptoms and vaginal changes make the leading suspicion.
First Tests
The first panel answers the most questions with the fewest draws: follicle-stimulating hormone (FSH), estradiol, prolactin and thyroid-stimulating hormone (TSH). Her results returned as follows. FSH was 68 IU/L, far above the follicular-phase range. Estradiol was below 20 pg/mL. Prolactin was 11 ng/mL and TSH 1.8 mIU/L, both normal.
A single high FSH does not establish the diagnosis, because ovarian function in this condition can fluctuate. The European Society of Human Reproduction and Embryology (ESHRE) guideline requires at least four months of disturbed or absent periods together with an FSH above 25 IU/L on two occasions more than four weeks apart, in a woman under 40 (ESHRE Guideline Group on POI, 2016). Her repeat FSH five weeks later was 74 IU/L. She meets the criteria.
A second high FSH, not the first, is what turns a suspicion into a diagnosis.
Looking for a Cause
Most cases have no identifiable cause, but three causes change care for the patient or her family and are tested in every case. Nelson (2009) emphasizes that the evaluation is as much about these consequences as about the label.
A karyotype looks for chromosomal causes such as Turner syndrome mosaicism or the presence of Y chromosome material, which would require removal of the gonads because of cancer risk. Hers is 46,XX.
FMR1 premutation testing looks for an expanded repeat in the fragile X gene. Women with the premutation have a higher rate of ovarian insufficiency, and their children can inherit the full mutation that causes fragile X syndrome. Her uncle's undiagnosed intellectual disability makes this test especially important. Her result shows a premutation-range repeat of 92 CGG repeats. She is referred to genetic counseling, and the counselor will discuss testing for her sister and her mother.
Adrenal autoantibodies, specifically 21-hydroxylase antibodies, screen for autoimmune ovarian insufficiency, which can occur alongside autoimmune adrenal insufficiency, a dangerous condition if missed. Hers are negative. Thyroid peroxidase antibodies are also checked, since autoimmune thyroid disease is common in this population; hers are negative, and her TSH will be repeated yearly.
What the Diagnosis Means
The diagnosis has four consequences beyond the missing periods.
Bone. Years of estrogen deficiency accelerate bone loss. A baseline bone density scan by dual-energy x-ray absorptiometry is ordered; her lumbar spine Z-score is minus 1.1, low for her age but not in the osteoporotic range.
Heart and longevity. Early loss of estrogen is associated with higher cardiovascular risk and earlier death, which is the main reason hormone replacement is recommended rather than offered as optional.
Fertility. Ms. Reyes and her husband had planned to try for a child next year. Ovarian function in this condition is intermittent rather than absent, and Nelson (2009) estimates that about five to ten percent of women conceive spontaneously after diagnosis. That figure is honest and small. She is referred to a reproductive endocrinologist to discuss options, including donor eggs, and is told she should not rely on the diagnosis as contraception if pregnancy would be unwelcome.
Emotional health. Many women describe the diagnosis as a loss. She is offered a referral to counseling and information on a patient support organization.
The Plan
Hormone replacement should continue at least until the average age of natural menopause, about 51, unless a contraindication appears (American College of Obstetricians and Gynecologists [ACOG], 2017). The aim is physiologic replacement, which requires higher estrogen doses than menopausal therapy. ACOG suggests transdermal estradiol at about 100 micrograms a day, with a cyclic progestogen such as micronized progesterone 200 milligrams for 12 days each month to protect the endometrium. Combined oral contraceptives are an alternative and provide contraception, but they deliver more estrogen than needed for replacement and stop for a placebo week; she prefers the patch because she may still try to conceive with treatment.
Other elements complete the plan: calcium and vitamin D intake reviewed with her diet, weight-bearing exercise, a repeat bone density scan in two to three years, a vaginal moisturizer for dryness until estrogen takes effect, and a visit in three months to check symptoms, blood pressure and her experience with the patch.
Follow-Up and Warning Signs
At three months the visit will review vasomotor symptoms, bleeding pattern and mood. Irregular bleeding beyond the expected withdrawal bleed, new headaches with visual changes, or calf pain or shortness of breath would prompt an earlier visit. Fatigue, dizziness, salt craving or darkening skin would prompt adrenal testing, even with negative antibodies now. Her genetic counseling appointment is in three weeks.
Conclusion
The workup started with the commonest explanations and ended with a less common one because the tests were chosen to separate them. A pregnancy test, FSH, estradiol, prolactin and TSH narrowed the field; a second FSH confirmed it; a karyotype, FMR1 test and adrenal antibodies looked for causes that matter to her family. The plan treats the diagnosis as a long-term health condition, with hormone replacement to the age of natural menopause, and leaves room for her plans about children.
References
American College of Obstetricians and Gynecologists. (2017). Committee opinion no. 698: Hormone therapy in primary ovarian insufficiency. Obstetrics & Gynecology, 129(5), e134-e141. https://doi.org/10.1097/AOG.0000000000002044
ESHRE Guideline Group on POI. (2016). ESHRE guideline: Management of women with premature ovarian insufficiency. Human Reproduction, 31(5), 926-937. https://doi.org/10.1093/humrep/dew027
Gordon, C. M., Ackerman, K. E., Berga, S. L., Kaplan, J. R., Mastorakos, G., Misra, M., Murad, M. H., Santoro, N. F., & Warren, M. P. (2017). Functional hypothalamic amenorrhea: An Endocrine Society clinical practice guideline. The Journal of Clinical Endocrinology & Metabolism, 102(5), 1413-1439. https://doi.org/10.1210/jc.2017-00131
Nelson, L. M. (2009). Primary ovarian insufficiency. New England Journal of Medicine, 360(6), 606-614. https://doi.org/10.1056/NEJMcp0808697
NU680 Unit 2 instructions, in plain terms
Unit 2 typically presents a patient whose periods have stopped or changed and asks for a structured workup: the history and examination findings that matter, a differential diagnosis, the tests ordered and why, the diagnosis and a management plan. Prompts often supply some results and expect the student to interpret them against named criteria. The assignment rewards reasoning in order, so the paper should show pregnancy excluded first, then the hormonal causes most likely for the patient's age and history. Many sections ask what the diagnosis means beyond the symptom, such as bone, heart or fertility consequences. Headings that walk from presentation to differential, tests, diagnosis and plan suit most rubrics, and the paper usually fills about five APA pages. Guidelines from specialty societies are the expected sources, and citing the specific criterion applied, rather than a general review, earns more credit.
How this NU680 Unit 2 example is built
The workup opens with her history and examination, including the uncle with an undiagnosed intellectual disability that later shapes the cause-finding tests. A differential section groups secondary amenorrhea into four sources and dismisses functional hypothalamic amenorrhea with reasons from her own life, citing the Endocrine Society guideline. The first tests are reported as values, and a highlighted line explains why only the second FSH confirms the diagnosis. A section on causes then explains what a karyotype, FMR1 premutation testing and adrenal antibodies would each change, and the premutation result leads to genetic counseling for her relatives. Consequences for bone, heart, fertility and mood each get a paragraph. The plan cites ACOG's committee opinion for transdermal estradiol with cyclic progesterone and explains why she chose that over a combined pill. Follow-up lists the symptoms that would prompt adrenal testing.
Where the points sit in the NU680 Unit 2 rubric
Rubrics for this workup generally reward diagnostic reasoning, accurate interpretation of results, use of current guidelines, a complete plan and clear writing. Reasoning credit depends on order: tests justified by the history earn more than a long panel ordered at once. Interpretation is scored against criteria, so stating the FSH threshold and the repeat interval the ESHRE guideline requires shows precision. Graders also look for the tests that matter to relatives, since FMR1 status carries implications beyond the patient. Plans earn the most when they address long-term health, not only the missing periods, with dose, route and duration specified. Fertility counseling that is honest about small chances is valued over vague reassurance. A follow-up schedule with warning signs completes the clinical criteria, and APA formatting with correct references for each guideline completes the writing marks in most sections.
Common NU680 Unit 2 mistakes, and how to avoid them
Workups lose marks when they skip the pregnancy test or list it last, or when a single FSH result is treated as diagnostic. Another frequent problem is ordering every hormone at once without explaining what each would show. Some papers diagnose primary ovarian insufficiency and stop, leaving out the karyotype, FMR1 testing and adrenal screening that the guideline expects. Others prescribe a menopausal dose of estrogen, which is too low for physiologic replacement in a woman of 33, or forget that a woman with a uterus needs a progestogen. Fertility is sometimes described as impossible, which is inaccurate. Before drafting, write the four broad sources of amenorrhea and the one test that would rule each in or out for your patient. Send your case and its results, and a custom workup can follow that reasoning for your patient.
Get an NU680 Unit 2 example written to your instructions
Share the case your unit assigns, the labs you have and the paper instructions with the rubric. A custom workup orders the differential, explains each test and states what the results would change for that patient. It arrives within 24-48h, and the first is free. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
More NU680 papers and MSN samples
- NU680 Unit 1: Sexual History Discussion Post
- NU680 Unit 3: Contraceptive Counseling Plan
- NU680 Unit 4: Infertility Evaluation Brief
- NU680 Unit 5: Seminar Reflection
- NU680 Unit 6: Genitourinary Syndrome Case Analysis
- NU680 Unit 7: Diagnostic Reasoning Paper
- NU680 Unit 8: Treatment Decision Paper
- NU680 Unit 9: Policy Brief
- NU680 Unit 10: Inclusive Care Plan
- MN501 Unit 2: Role Analysis Paper
- NU678 Unit 2: Log Narrative, Alcohol Missed
- MN502 Unit 2: Philosophy of Nursing Statement
- NU677 Unit 2: Selective Mutism Assessment Write-Up
NU680 Unit 2 questions, answered
What tests are usually expected first in an amenorrhea workup?
A pregnancy test comes first in nearly every case, followed by FSH, prolactin and TSH. Further tests depend on those results and the history. Explaining why each test is ordered, and what a result would mean, earns more than listing a panel.
Can an amenorrhea paper include treatment?
Yes, once the diagnosis is established. Most prompts want the workup and diagnosis first, then a management plan. Keep treatment tied to the cause you found, since the right plan for one cause is wrong for another.
How long is a typical Unit 2 workup paper?
Often four to six pages in APA format, depending on the section. Use headings that follow the reasoning: presentation, differential, tests and results, diagnosis and plan. A short table of results can save space.
Where can I find a free NU680 Unit 2 sample paper?
This page holds the complete NU680 Unit 2 amenorrhea workup paper. It follows a composite 33-year-old from a negative pregnancy test through two FSH results to primary ovarian insufficiency, then sets out cause-finding tests, hormone replacement and follow-up.
Why does the NU680 Unit 2 sample order FMR1 testing?
Women with an FMR1 premutation have higher rates of ovarian insufficiency, and their children can inherit fragile X syndrome. The patient's uncle had an undiagnosed intellectual disability, so the result matters for her relatives as well as her own care.