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Seminars in Reproductive Medicine Mar 2022Primary amenorrhea may be a feature or a presenting sign of a difference of sex development, most often due to a congenital anatomic difference or hypergonadotropic...
Primary amenorrhea may be a feature or a presenting sign of a difference of sex development, most often due to a congenital anatomic difference or hypergonadotropic hypogonadism. History and physical exam are very important, including whether any variation in external genitalia was present at birth as well as a careful review of pubertal development. Further evaluation includes hormone measurement, imaging, and genetic evaluation. Those with a disorder of sexual development diagnosis should receive care through a multidisciplinary team with psychosocial support.
Topics: Amenorrhea; Female; Humans; Hypogonadism; Infant, Newborn; Sexual Development
PubMed: 35772411
DOI: 10.1055/s-0042-1753551 -
Abdominal Radiology (New York) Jul 2021This is a pictorial review on the radiological approach to patients with amenorrhea using a level-based framework. The prevalence of amenorrhea is 3 to 4% with... (Review)
Review
This is a pictorial review on the radiological approach to patients with amenorrhea using a level-based framework. The prevalence of amenorrhea is 3 to 4% with wide-ranging causes involving multiple clinical disciplines. Normal menstruation depends on complex coordinated hormonal functions of the hypothalamic-pituitary-ovarian axis exerting its effect on an intact uterine end-organ and outflow tract. A disruption of any of these factors may result in amenorrhea. Categorizing the causes of primary and secondary amenorrhea into uterine, ovarian/gonadal, and intracranial levels provides a logical framework for its evaluation. A systematic level-based approach by targeted ultrasound of the pelvic structures is suggested, with different aims in primary versus secondary amenorrhea. Pelvic sonographic findings of various conditions within the uterine and ovarian/gonadal levels are illustrated. Conditions due to an intracranial cause result in downstream effects on the uterus and ovaries and can often be suspected based on a combination of clinical assessment, ultrasound findings, and laboratory investigations. By correlating pelvic ultrasound findings with underlying pathology, the clinical radiologist is able to provide useful diagnostic information in the management of these patients.
Topics: Amenorrhea; Female; Humans; Ovary; Pelvis; Ultrasonography; Uterus
PubMed: 33569613
DOI: 10.1007/s00261-021-02961-9 -
Endocrine, Metabolic & Immune Disorders... 2022Eating Disorders (ED) are associated with multiple physical complications that strongly affect the physical health of these young and fragile patients and can also cause...
Eating Disorders (ED) are associated with multiple physical complications that strongly affect the physical health of these young and fragile patients and can also cause significant mortality, the highest among psychiatric pathologies. Among the various organic complications, albeit still little known, the gynecological implications, up to infertility, are very widespread. Both among adolescent and adult patients, gynecological symptoms can be very widespread and range from menstrual irregularities to amenorrhea, from vaginitis to ovarian polycystosis, up to complications during the gestational phase and in postpartum, in addition to the possible consequences on the unborn child. Among the most frequent and significant gynecological disorders in women with ED, there are menstrual irregularities that may occur with oligomenorrhea or even amenorrhea. This symptom, although no longer part of the DSM-5 diagnostic criteria for defining Anorexia Nervosa (AN), must be considered a very relevant event in the overall evaluation of young women and adolescents with eating disorders. Functional Hypothalamic Amenorrhea in ED patients is related to psychological distress, excessive exercise, disordered eating, or a combination of these factors which results in suppression of the hypothalamic- pituitary-ovarian axis, resulting in hypoestrogenism. The objective of this paper is to summarize the causes and the mechanism underlying the menstrual disorders and to provide a better understanding of the correlation between the reproductive system and the mechanisms that regulate food intake and eating habits. In addition, early recognition of risk factors for eating disorders for gynecological implications can help put more accurate assessments of patients to prevent potentially fatal complications. The importance of the involvement of specialist gynecologists in the multidisciplinary team that has to follow patients with eating disorders is also discussed.
Topics: Adolescent; Adult; Amenorrhea; Anorexia Nervosa; Feeding and Eating Disorders; Female; Humans; Menstruation Disturbances; Oligomenorrhea
PubMed: 34182917
DOI: 10.2174/1871530321666210625145345 -
BMJ Case Reports May 2015
Topics: 46, XX Disorders of Sex Development; Amenorrhea; Congenital Abnormalities; Female; Humans; Magnetic Resonance Imaging; Mullerian Ducts; Young Adult
PubMed: 25979964
DOI: 10.1136/bcr-2015-210187 -
Spinal Cord Aug 2022This was a single-centre, prospective, descriptive, hospital-based study in females with spinal cord injuries (SCI).
STUDY DESIGN
This was a single-centre, prospective, descriptive, hospital-based study in females with spinal cord injuries (SCI).
OBJECTIVES
To study menstrual changes after SCI.
SETTING
The in-patient and out-patient services of the Department of Physical Medicine and Rehabilitation of a tertiary care institute in India between October 2018 and October 2020.
METHODS
SCI females who were included in the study answered a questionnaire regarding amenorrhea after injury, menstrual cycle regularity, frequency, duration, flow, dysmenorrhoea and presence of autonomic dysreflexia during menstruation. All the study related data was analysed using SPSS version 24. A p value < 0.05 was considered as statistically significant.
RESULTS
40 females were included. 31 (77.5%) had amenorrhea. The mean duration of return of menstruation was 2.65 months. There was significant reduction in the duration of menstrual flow (p value < 0.001), amount of flow (p value = 0.041) and dysmenorrhea (p value < 0.001) after SCI.
CONCLUSIONS
Amenorrhea was seen in 77.5% females. Most of them resumed their menstrual cycle. The menstruation duration and flow were reduced significantly. There is a need to address concerns and reassure females regarding resumption of menstruation after SCI.
Topics: Amenorrhea; Dysmenorrhea; Female; Humans; Male; Menstruation; Prospective Studies; Spinal Cord Injuries
PubMed: 35169301
DOI: 10.1038/s41393-022-00765-2 -
Best Practice & Research. Clinical... Jan 2024Premature ovarian insufficiency (POI) is a condition in which there is a decline in ovarian function in women who are younger than 40 years resulting in a... (Review)
Review
Premature ovarian insufficiency (POI) is a condition in which there is a decline in ovarian function in women who are younger than 40 years resulting in a hypo-oestrogenic state with elevated gonadotrophins and oligomenorrhoea/amenorrhoea. This leads to short term complications of menopausal symptoms and long-term effects on bone and cardiovascular health, cognition as well as the impact of reduced fertility and sexual function associated with this condition. It is managed by sex steroid replacement either with HRT or combined hormonal contraception until the age of natural menopause (51) and this can provide a beneficial role with both symptom control and minimising the long-term adverse effects associated with this condition. Women who undergo a menopause between 40 and 45 years are deemed to have an "early menopause". The limited data available for this group suggest that they also have an increased morbidity if not adequately treated with hormone therapy. As such, women who have an early menopause should be managed in a similar way to those with POI, with the recommendation that they should take HRT at least until the natural age of menopause. This is the same for induced menopause that is caused by medical or surgical treatment that impacts the ovaries. It is important to ensure early diagnosis and access to specialist care to help support and manage these patients to reduce the symptoms and risks of long-term complications. This review looks at the diagnosis, causes, short and long-term complications and management of POI, early and induced menopause.
Topics: Humans; Female; Primary Ovarian Insufficiency; Menopause, Premature; Menopause; Amenorrhea
PubMed: 37802711
DOI: 10.1016/j.beem.2023.101823 -
JAAPA : Official Journal of the... Oct 2014
Topics: Adolescent; Adult; Amenorrhea; Female; Humans; Young Adult
PubMed: 25251655
DOI: 10.1097/01.JAA.0000453871.15689.a2 -
Obstetrics and Gynecology Oct 2015There is a growing population of women who have or will undergo hematopoietic stem cell transplant for a variety of malignant and benign conditions. Gynecologists play...
There is a growing population of women who have or will undergo hematopoietic stem cell transplant for a variety of malignant and benign conditions. Gynecologists play an important role in addressing the gynecologic and reproductive health concerns for these women throughout the transplant process. As women undergo cell transplantation, they should avoid becoming pregnant and are at risk of uterine bleeding. Thus, counseling about and implementing hormonal treatments such as gonadotropin-releasing hormone agonists, combined hormonal contraceptives, and progestin-only methods help to achieve therapeutic amenorrhea and can serve as contraception during the peritransplant period. In this commentary, we summarize the timing, risks, and benefits of the hormonal options just before, during, and for the year after hematopoietic stem cell transplantation.
Topics: Amenorrhea; Contraception; Ethinyl Estradiol; Female; Hematopoietic Stem Cell Transplantation; Humans; Menorrhagia; Pregnancy
PubMed: 26348182
DOI: 10.1097/AOG.0000000000001031 -
The Cochrane Database of Systematic... Oct 2015It is estimated that about 40% of pregnancies in the world are unintended and that the major part of these are unwanted. There are several reasons no or ineffective... (Review)
Review
BACKGROUND
It is estimated that about 40% of pregnancies in the world are unintended and that the major part of these are unwanted. There are several reasons no or ineffective contraception is used to prevent these pregnancies, including difficulty in obtaining contraceptives. The lactational amenorrhoea method (LAM) is a contraceptive method where the mother is informed and supported in how to use breastfeeding for contraception. LAM is available and accessible to many women.
OBJECTIVES
To assess the effectiveness of LAM, as defined in the 1988 Bellagio Consensus statement, as a contraceptive method in fully breastfeeding women, who remain amenorrheic, using pregnancy and menstruation life tables.
SEARCH METHODS
We searched MEDLINE, EMBASE, POPLINE, and LILACS to 10 October 2014; reference lists of studies; review articles; books related to LAM; published abstracts from breastfeeding, reproductive health conferences; e-mails with study coordinators.
SELECTION CRITERIA
Out of 459 potentially relevant studies, 159 investigated the risk of pregnancy during LAM or lactational amenorrhoea. Our inclusion criteria were as follows: prospective study; cases (intervention group) and, if available, controls, had to be sexually active; pregnancy had to be confirmed by physical examination or a pregnancy test. Our endpoints were life table menstruation rates and life table pregnancy rates. We included 15 studies reporting on 11 intervention groups and three control groups. We identified one additional uncontrolled study in the 2007 update and one additional controlled study in this 2015 update.
DATA COLLECTION AND ANALYSIS
Two review authors independently extracted data, resolving disagreements through discussion. We analysed the studies using narrative methods because of their heterogeneity.
MAIN RESULTS
For the primary outcome, pregnancy, two controlled studies of LAM users reported life table pregnancy rates at six months of 0.45% and 2.45%, one controlled study reported 5% pregnancies in the absence of life table rates per month, and eight uncontrolled studies of LAM users reported pregnancy rates of 0% to 7.5%. Life table pregnancy rates for fully breastfeeding women who were amenorrheic but not using any contraceptive method were 0.88% in one study and 0.9% to 1.2% (95% confidence interval 0.0 to 2.4) in a second study, depending on the definition of menstruation used. The life table menstruation rate at six months in all studies varied between 11.1% and 39.4%.
AUTHORS' CONCLUSIONS
We found no clear differences in life table pregnancy rates between women using LAM and being supported in doing so, and fully breastfeeding amenorrheic women not using any method. As the length of lactation amenorrhoea in women using LAM differed greatly between the populations studied, and was population specific, it is uncertain whether LAM extends lactational amenorrhoea.
Topics: Amenorrhea; Breast Feeding; Contraception; Contraception Behavior; Family Planning Services; Female; Humans; Lactation; Life Tables; Menstruation; Postpartum Period; Pregnancy; Pregnancy Rate
PubMed: 26457821
DOI: 10.1002/14651858.CD001329.pub2 -
Clinical NeuropharmacologyVortioxetine is a novel multimodal antidepressant for the treatment of major depressive disorders and is widely used in clinical practice. Vortioxetine has a safe...
BACKGROUND
Vortioxetine is a novel multimodal antidepressant for the treatment of major depressive disorders and is widely used in clinical practice. Vortioxetine has a safe profile. However, there are case reports of other adverse effects in the literature. In this article, a case of amenorrhea due to vortioxetine is presented.
CASE
The patient is 36 years old, married, female, and is an anesthesiologist. She applied to the psychiatric outpatient clinic with symptoms of major depression. Vortioxetine was initiated at 10 mg/d and then gradually increased to 20 mg/d. She had regular menstruation until now. However, she did not menstruate after taking vortioxetine. The patient used vortioxetine for 3 months and never had a period. Pregnancy test and other tests to investigate organic etiology were normal. Two weeks after discontinuation of vortioxetine, the patient had a menstrual period.
CONCLUSIONS
Further research is needed on the relationship and possible mechanisms between vortioxetine and amenorrhea.
Topics: Adult; Amenorrhea; Antidepressive Agents; Depressive Disorder, Major; Female; Humans; Vortioxetine
PubMed: 35029863
DOI: 10.1097/WNF.0000000000000490