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Query: UMLS:C0002453 (amenorrhea)
 6,245 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The US Food and Drug Administration 1st approved the Norplant Contraceptive System in December 1990. Norplant clinical trials with 55,000 volunteers in 41 countries attest to its effectiveness as a safe and convenient longterm and reversible contraceptive. In 10-15 minutes, clinicians can insert the system's 6 silastic capsules containing levonorgestrel under the dermis of the inner side of the upper arm. Within 24 hours after insertion, Norplant can effectively protect from pregnancy. The capsules continuously release the levonorgestrel over 5 years to protect ovulation. Norplant can be used by almost all women including adolescents, postpartum women, and lactating mothers 6 weeks after delivery. It is especially suitable for women who want longterm birth spacing, to abstain from sterilization, who have encountered problems with other contraceptives, and who do not want to take estrogen. Women with active thrombophlebitis, thromboembolic disease, cardiovascular disease, undiagnosed abnormal vaginal bleeding, known or suspected pregnancy, acute liver disease, benign or malignant liver tumors, and breast cancer should not use Norplant, however. Its side effects include prolonged bleeding, spotting, and amenorrhea. High initial costs for Norplant in the US (range $500-1000) are preventing many women from adopting its use. In Tennessee, Medicaid and some private insurance companies cover Norplant insertion. Clinicians must provide adequate counseling, education, and patient advocacy in addition to proper skills for Norplant insertion and monitoring. Wyeth Laboratories has trained 25,000 physicians who have trained their medical colleagues and nurse practitioners. The nurse practitioner training programs at Emory University in Atlanta, Georgia includes Norplant insertion skills in its curriculum. The Tennessee Department of Health offers the public a network of trained Norplant providers. It also is working on developing Norplant guidelines including policy, procedures, medical management, counseling, and informed consent.
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PMID:Norplant. 162 59

Several European studies have been conducted to confirm the efficacy, tolerability, and safety of a new oral contraceptive (OC) combining 250 micrograms norgestimate with 35 micrograms ethinyl estradiol (Ortho-Cyclen or Cilest). In a 12-month multicenter German study of 147 women, treatment with this formulation resulted in no pregnancies, a low incidence of side effects, and excellent cycle control. The drug had no effect on estrogen-mediated fibrin formation nor on the activity of coagulation inhibiting or promoting factors. Similarly, the documented low androgenicity of the highly selective progestational agent norgestimate results in a more positive metabolic profile. Glucose, insulin, and hemoglobin A1c concentrations measured before and after glucose loading were not adversely affected by treatment with the norgestimate-containing OC, and all changes were reversible on its discontinuation. In addition, lipid metabolism was positively influenced by the drug. Low-density lipoprotein cholesterol, a known risk factor for cardiovascular disease, was reduced while the cardioprotective lipid fraction, high-density lipoprotein cholesterol, was increased. Clinical trials to determine the OC's effects on coagulation, endocrine function, and carbohydrate and lipid metabolism are reviewed. Also discussed are several studies demonstrating the formulation's unique endometrial effects, which may possibly be related to its low androgenic activity and consequent low incidence of breakthrough bleeding and amenorrhea.
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PMID:Supportive European data on a new oral contraceptive containing norgestimate. 218 83

Most patients who have a change in menstruation can be evaluated and treated on the basis of a brief history, a physical examination, and a few laboratory tests. Because menstrual dysfunction can cause worry and inconvenience, patients should be promptly treated. Pregnancy must be excluded as a cause of amenorrhea in the initial evaluation. Other possible causes that must be ruled out include hypothalamic or pituitary tumors and severe thyroid disease. Amenorrhea should be treated to avoid possible complications such as osteoporosis, cardiovascular disease, and uterine or endometrial cancer. Treatment methods depend on whether the lack of menstruation is caused by an excessive estrogen level or estrogen deficiency.
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PMID:Solving the mystery of menstrual dysfunction. 265 5

Athletes engage in a number of dietary and weight control practices which may influence metabolism, health, and performance. This paper reviews the literature on these factors with special emphasis on athletes who show large, frequent, and rapid fluctuations in weight (wrestlers) and athletes who maintain low weight and low percent body fat (e.g., distance runners, gymnasts, and figure skaters). A theory is presented which relates these weight patterns and the accompanying dietary habits to changes in body composition, metabolism, metabolic activity of adipose tissue, and the distribution of body fat. Changes in these physiological variables may be manifested in enhanced food efficiency (weight as a function of caloric intake) as the body seeks to protect and replenish its energy stores. This may explain the surprisingly low caloric intakes of some athletes. The health status of the athlete is a concern in this regard because there may be changes in fat distribution, risk factors for cardiovascular disease, and hormonal factors associated with reproductive functioning in both females and males. Amenorrhea in female athletes may be mediated at least in part by regional fat distribution; depletion of femoral fat depots (lactational energy reserves) may be the stimulus for cessation or disruption of menses.
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PMID:Weight regulation practices in athletes: analysis of metabolic and health effects. 332 66

Prescription of oral contraceptives is reviewed by giving practical tips on the absolute contraindications, timing of the first dose, dose of estrogen, choice of type of progestin, reasons for changing the combination, and a list of benefits of oral contraceptives. The major risk in taking orals is cardiovascular disease, but actual risks are clustered in subsets of women. Those at high risk are women over 45, smokers over 35, and smokers of any age with cardiovascular risk factors. Generally women should start with a 30 or 35 mcg estrogen combined pill, and perhaps consider taking a higher estrogen dose if they experience breakthrough bleeding or amenorrhea. The 1st cycle can be started at any time up to 6 days after Cycle Day 1 or after spontaneous or induced abortion. Women taking bromocriptine should also begin contraception soon after delivery. Signs of potential major complications are abdominal pain, chest pain or dyspnea, headache or neurologic symptoms, visual or speech problems, or leg pain or weakness. Benefits of oral contraception include menstrual regulation, decreased menstrual flow, prevention of functional ovarian cysts, protection against ovarian and endometrial cancer by half, against benign breast disease, and possibly against pelvic inflammatory disease.
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PMID:Oral contraceptives. Who, which, when, and why? 362 38

Since 1969, 184 previously untreated and evaluable adult patients with Hodgkin's disease, staged as I (43) or II (141), have been treated. Eighty patients were part of the National Hodgkin's Disease Study, randomly assigned to receive radiotherapy to either an involved (39) or extended field (41). In a subsequent single-arm study, 104 patients were treated with involved-field radiotherapy preceded and followed by three cycles of MOPP chemotherapy. Median durations of follow-up have been 172, 172, and 92 months, for the involved-field radiotherapy, extended-field radiotherapy, and MOPP plus involved-field radiotherapy treatment groups, respectively. Although significant differences among the three treatment groups were observed with respect to disease-free survival (p less than 0.001), only the group of patients treated with involved-field radiotherapy had a statistically significant decline in overall survival as compared with the two other treatment groups (p less than 0.001). Moreover, patients who underwent clinical staging and were treated with MOPP plus involved-field radiotherapy had significantly prolonged disease-free survival compared with those who underwent surgical staging and were treated with extended-field radiotherapy (p less than 0.001). One of the patients who received MOPP plus involved-field radiotherapy had subsequent development of acute monocytic leukemia, and another had refractory anemia with excess blasts. One instance of diffuse poorly differentiated lymphocytic lymphoma was also observed. Acute monocytic leukemia developed in another patient treated with involved-field radiotherapy. The rates of amenorrhea in the group treated with MOPP plus involved-field radio-therapy were 9.6 percent and 78.5 percent for female patients younger and older than 30 years of age, respectively. Despite the universal azoospermia ensuing after MOPP plus involved-field radiotherapy, in three patients whose sperm counts were checked sequentially for 26 to 53 months after treatment, evidence of spermatogenesis was observed. Three patients with remission of Hodgkin's disease after involved-field (two) and extended-field (one) radiotherapy died from cardiovascular disease that could only be attributed to the prior radiotherapy. Although further follow-up evaluation will be required to determine the impact of the three different treatment modalities on survival and long-term toxicity, MOPP plus involved-field radiotherapy appears to be superior to involved-field or extended-field radiotherapy alone in achieving prolonged disease-free survival without significant leukemogenic potential.
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PMID:Treatment of stages I and II Hodgkin's disease with three different therapeutic modalities. 375 85

This paper presents a state-of-the-art review of oral contraceptives (OCs), termed one of the epochal developments of modern times. OCs have had both direct and indirect influences on moral, social, and cultural values and on the interaction of population resources and the environment. In recent years there has been a trend away from OC use because of increased mortality rates, especially in women over 35 years of age and smokers. However, epidemiologic studies have indicated that the incidence of death from cardiovascular disease, thromboembolic disease, and stroke was greatly reduced when newer preparations with lower steroidal doses became available. The reduction of the estrogen content from 150 mcg of ethinyl estradiol-3-methylether to 30-35 mcg of ethinyl estradiol and of the progestin component from 10 mg of norethindrone to 1 mg or less has not interefered with effective conception control. The progestin component of the pill was linked to high blood pressure, lipid changes, and cardiovascular changes with an unfavorable impact on arterial disease. Although many insist that the question of whether OCs cause or predispose to cardiovascular problems cannot be answered at this time, the potential risks involved in OC use are generally regarded to be outweighed by the benefits. Reductions in OC dosages have also reduced the incidence of galactorrhea, amenorrhea, and on-pill amenorrhea. New triphasic formulations that more closely imitate the hormonal fluctuations of the menstrual cycle are considered to hold much promise in terms of safety and effectiveness.
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PMID:Oral contraceptives: the state of the art. 391 70

Ethinyl estradiol is the only estrogen form used in low-dose oral contraceptive (OC) pills. Progestogenic compounds used in OCs include norethindrone, norethindrone acetate, ethynodiol diacetate, norgestrel, levonorgestrel, and norethynodrel. The newest third generation progestins are desogestrel and norgestimate. The most important benefits associated with OC use are a decrease in benign breast disease, less incidence of ovarian and endometrial cancers, and a decrease in the incidence of pelvic inflammatory disease. The most serious risks to OC users who are over age 35 and smoke are deep vein thrombosis, pulmonary embolus, retinal thrombosis, or cardiovascular disease. Other risk factors for cardiovascular disease include obesity, diabetes, hypertension, increased serum cholesterol, and a family history of premature myocardial infarction. All users should have blood pressure checks 3 and 6 months after commencing pill use. OC preparations cause an increase in total cholesterol, triglycerides, low density lipoprotein (LDL), very low density lipoprotein (VLDL), and a decrease in high density lipoprotein (HDL), but norgestimate may actually increase HDL levels. Preparations with levonorgestrel may produce the greatest decrease in glucose tolerance, while those with 35 mcg of ethinyl estradiol and 0.5 mg of norethindrone have the least effect. OCs do not increase the risk of developing breast cancer, but can stimulate the growth of breast cancer once it has occurred. The incidence of gallbladder disease is increased slightly in OC using women who are predisposed. Hepatocellular adenomas are associated with combined OC use. Underweight women are more prone to side effects and need a very low potency preparation. A common problem encountered by patients on OCs is amenorrhea. This usually resolves after 3 cycles. Breakthrough bleeding is also very common. Post-pill amenorrhea is frequently found after stopping OCs. Combined oral contraceptives are a safe and effective contraceptive method for most women throughout their reproductive years.
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PMID:Combined oral contraceptive pills: a brief review. 783 35

To determine the interactive effects of hormones, exercise, and diet on plasma lipids and lipoproteins, serum estrogen and progesterone levels, nutrient intake, and plasma lipid, lipoprotein, and apolipoprotein concentrations were measured in 24 hypoestrogenic amenorrheic and 44 eumenorrheic female athletes. When compared to eumenorrheic athletes, amenorrheic athletes had higher levels of plasma cholesterol (5.47 +/- 0.17 vs. 4.84 +/- 0.12 mmol/L, P = 0.003), triglyceride (0.75 +/- 0.06 vs. 0.61 +/- 0.03 mmol/L, P = 0.046), low-density lipoprotein (LDL; 3.16 +/- 0.15 vs. 2.81 +/- 0.09 mmol/L, P = 0.037), high-density lipoprotein (HDL; 1.95 +/- 0.07 vs. 1.73 +/- 0.05 mmol/L, P = 0.007), and HDL2 (0.84 +/- 0.06 vs. 0.68 +/- 0.04 mmol/L, P = 0.02) cholesterol. Plasma LDL/HDL cholesterol ratios, very low-density lipoprotein and HDL3 cholesterol, and apolipoprotein A-I and A-II levels were similar in the two groups. Amenorrheic athletes consumed less fat than eumenorrheic subjects (52 +/- 5 vs. 75 +/- 3 g/day, P = 0.02), but similar amounts of calories, cholesterol, protein, carbohydrate, and ethanol. HDL cholesterol levels in amenorrheic subjects correlated positively with the percent of dietary calories from fat (r = 0.42, n = 23, P = 0.045) but negatively with the percent from protein (r = -0.49, n = 23, P = 0.017). Thus, exercise-induced amenorrhea may adversely affect cardiovascular risk by increasing plasma LDL and total cholesterol. However, cardioprotective elevations in plasma HDL and HDL2 cholesterol may neutralize the risk of cardiovascular disease in amenorrheic athletes.
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PMID:Elevated plasma low-density lipoprotein and high-density lipoprotein cholesterol levels in amenorrheic athletes: effects of endogenous hormone status and nutrient intake. 826 48

Ovarian failure is a common consequence of chemotherapy and radiotherapy in women undergoing bone marrow transplantation. The longer survival in these women has raised, during the past years, the need for a better quality of life. The objective of the present study has been to evaluate perspectively the potential benefit of hormonal replacement therapy in 24 women who underwent bone marrow transplantation. The data obtained indicated that hormonal replacement therapy results effective in preventing and/or relieving the multiple manifestations of gonadal failure, including amenorrhea, hot flashes, atrophy of genital apparatus, osteoporosis and cardiovascular disease.
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PMID:[Efficacy of estrogen-progestin replacement therapy after bone marrow transplantation]. 899 81


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