A 15 year old non-sexually active obese female presents to your office for treatment options for irregular bleeding and hirsutism.  She states that she has always had irregular menses, but that in the last year, she has only had her period once.  She also complains that she has more hair on her face and stomach than her mother and sisters.   She says that she has gained 15 pounds in the last year despite dieting and engaging in occasional exercise.  She denies vaginal discharge.  Mom states that the patient looks as if she is “bloated” and that she is becoming unhappy due to the weight gain.  Mom states that the patient usually skips breakfast, then eats pizza (on most days) for lunch at school and a plate of rice and beans for dinner.  Despite this “nutritious” diet, mom states that the patient is gaining weight and this is making her depressed.