Problem:
PARAPHRASE: In a 48-year-old woman with irregular periods, how do you clinically distinguish between menstrual irregularity caused by hypothyroidism versus perimenopause, given that both conditions are common in this age group and can coexist? What role, if any, should hormonal testing (FSH, estradiol) play in this workup, and how do the ACOG/Choosing Wisely guidance influence your decision? Need Assignment Help?