Review Question - QID 109610

A 35-year-old G0P0000 woman presents to her gynecologist with complaints of irregular menstruation. She has had only 2 periods in the last year. She feels flushed without provocation and is experiencing occasional dyspareunia with post-coital spotting. She has also had more frequent headaches than usual. The patient has a medical history of Hashimoto thyroiditis and takes levothyroxine daily. Her mother has type 1 diabetes mellitus. Her temperature is 98.5°F (36.9°C), pulse is 70/min, blood pressure is 118/76 mmHg, and respirations are 13/min. Cardiopulmonary and abdominal exams are unremarkable. The patient has Tanner 5 breasts and pubic hair. A pelvic exam reveals a normal cervix, an anteverted uterus without tenderness, and no adnexal masses. The following laboratory studies are performed:

Serum:
Thyroid stimulating hormone (TSH): 28 µIU/mL (9-30 µIU/mL)
Cycle day 3 follicle stimulating hormone (FSH): 49 mIU/mL (4.7-21.5 mIU/mL)
Cycle day 3 estradiol: 8 pg/mL (27-123 pg/mL)
Prolactin: 14 ng/mL (4-23 ng/mL)
Testosterone: 42 ng/dL (15-70 ng/dL)

Which of the following is the most appropriate next step in management?