A 39 year-old female patient presents to the clinic with a history of fatigue, puffy eyes and dry skin. She reports that she has been experiencing increasing "brain fog" and has trouble concentrating at her work, which is medical billing/coding at the large city hospital. She also reports that she is "always tired," and thinks she "has gained some weight." She says that she lacks energy and feels "blue" and "depressed," some of the time. She has noted "irregularity in her periods." Her last menstrual period was 7 weeks ago, and it was "very heavy."