clinical practice T h e ne w e ngl a nd jou r na l o f m e dic i ne This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations. n engl j med 360;6 nejm. A 30-year-old woman presents with a history of no menses since she stopped taking oral contraceptives 6 months ago in order to conceive.

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... e had undergone puberty that was normal in both timing and development, with menarche at 12 years of age. At 18 years of age, she started taking oral contraceptives for irregular menses. She reports stress at work. Her weight is 59 kg, and her height 1.66 m; her body-mass index (the weight in kilograms divided by the square of the height in meters) is 21.3. There is no galactorrhea, hirsutism, or acne. The pelvic examination is normal, a pregnancy test is negative, the prolactin level is normal, and the follicle-stimulating hormone (FSH) level is in the menopausal range. How should she be evaluated and treated? The Clinic a l Problem clinical pr actice n engl j med 360;6 nejm.org february 5, 2009 Welt CK. Primary ovarian insufficiency: 3. a more accurate term for premature ovarian failure. Clin Endocrinol (Oxf) 2008; 68:499-509. Rebar RW, Connolly HV. Clinical fea- 4. tures of young women with hypergonado-