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

It has been suggested in the past that some normoprolactinemic patients with amenorrhea or infertility respond to treatment with bromocriptine. However, the beneficial effect of this therapy in normoprolactinemic women remains controversial. Some authors have suggested that the responders suffer with "reactive" hyperprolactinemia and that this may be detected with thyrotropin releasing hormone (TRH) stimulation. In this study, we performed TRH stimulation tests in 538 patients with ovulatory dysfunction. Only those patients showing a peak prolactin response after TRH which exceeded 40 ng/ml were treated with bromocriptine. A direct correlation between peak prolactin level after TRH and a favorable response to treatment was observed. Serum testosterone and DHEA-sulfate levels did not correlate with prolactin response to TRH. A majority of patients with prolactin hyperresponse to TRH did not show a hyperresponse of TSH to TRH. This study suggests that incidence of beneficial response to bromocriptine therapy in normoprolactinemic women with ovulatory dysfunction is significantly higher in subjects exhibiting excessive prolactin response to TRH stimulation.
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PMID:Prolactin response to thyrotropin-releasing hormone in normoprolactinemic patients with ovulatory dysfunction and its use for selection of candidates for bromocriptine therapy. 214 56

Risk factors for ectopic pregnancy include previous ectopic pregnancy, current intrauterine device use, prior fallopian tube surgery, previous pelvic inflammatory disease and a prior history of infertility. Abdominal pain is the most common symptom, followed by amenorrhea or vaginal bleeding, nausea, vomiting, syncope and dizziness. Referred shoulder pain following the onset of abdominal pain is characteristic of intraperitoneal bleeding and, in the appropriate clinical setting, strongly suggests a ruptured ectopic pregnancy. A coordinated evaluation includes measurement of serum human chorionic gonadotropin concentration and transabdominal or, preferably, transvaginal ultrasonography. Treatment is primarily by one of a variety of surgical techniques. Medical therapy with methotrexate or other drugs is currently under investigation.
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PMID:Management of ectopic pregnancy. 218 38

This is a comprehensive review of the risk of infertility or adverse effects on pregnancy outcome, such as chromosomal or congenital birth defects, amenorrhea, pelvic inflammatory disease (PID), or spontaneous abortion, after use of oral contraceptives, IUDs, induced abortion or spermicides. The sequelae reported for orals are chromosomal abnormalities, the VACTERL anomalies, masculinization of female fetus, Down's syndrome and post-pill amenorrhea. Several large studies found no increased risks for birth defects, although the risk of malformations when pregnant women inadvertently take the pill in early pregnancy was high in 1 of 2 such studies. Masculinization was reported with high dose combined hormone treatment and in 2 infants of a woman who took Enovid. the bulk of recent studies on secondary amenorrhea indicate that it is rare, but just as likely to occur in women with prior normal or abnormal menstrual patterns. One study found that amenorrhea is 7.7 times more likely to develop in women who took the pill to regulate menses. It is recommended that women with amenorrhea be screened for pituitary tumors and counseled before prescribing pills, and that those who fail to ovulate after stopping the pill be treated at least 6 months with clomiphene. A massing of all studies on the impact of 1st trimester induced abortion on subsequent fertility, premature delivery and spontaneous abortion, shows all relative risks around 1.0. After multiple abortions, the results are conflicting. In contrast, prior series analyzing illegal abortion have an unquestioned adverse effect on fertility and pregnancy outcome. Asherman's syndrome, a rare disorder of intrauterine adhesions, menstrual abnormalities, infertility and habitual abortion, has been associated with D & C abortion concurrent with pelvic sepsis, or traumatic pregnancy with D & C. This condition can be treated with moderate success. The bulk of IUD studies conclude that there is no overall decrement in fertility, while some disaggregated studies point the Dalkon shield as a higher risk and copper IUDs as a lower risk. PID and its consequences are now considered related to the immediate post-insertion time frame, or specifically to women who are at risk of contracting sexually transmitted disease, i.e., those with multiple partners, those with prior PID and nulliparas. Comprehensive review of current large series on spermicides shows no relationship between their use and spontaneous abortion or congenital malformation.
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PMID:Fertility after contraception or abortion. 220 74

Infertility is a serious problem in Africa; affecting large number of women and causing much suffering. To address this problem an infertility clinic was opened in an isolated District General Hospital in Ghana. Statistics were kept over an 18-month period to identify the numbers of patients involved and the main cause of infertility. 1000 patients were registered during the course of twice-weekly clinics over 18 months. 118 patients (11.8%) became pregnant during this time and in 482 (48.2%) others a definite diagnosis was reached. The remaining patients were still under investigation or lost to follow-up at the end of the study period. Of the 118 pregnancies 40% had suffered from primary and 60% from secondary infertility. The duration of infertility ranged from 1 to 10 years. As expected the "successful" patients tended to be young (65% under 25 years) and to have had subfertility of limited duration (77% 4 years). 113 patients had evidence of tubal damage (43% primary and 57% secondary infertility), 63% had a history of pelvic inflammatory disease and 37% had a history of abdominal or pelvic surgery. 219 male partners were subfertile: 38% were azoospermic; 33% severely oligospermic ( 5 x 10 to the 6th power/ml); 29% moderately oligospermic (20 x 10 tot he 6th power/ml); and 40% had never fathered a child. 61 patients were anovulatory as judged by amenorrhea or an irregular menstrual cycle. 10 of them were thought to be perimenopausal. 37 patients had uterine factors (27% primary and 73% secondary). 33 women had fibroids, 2 congenital abnormalities and 2 previous subtotal hysterectomies. 52 patients had unexplained infertility, although there were associated factors in 5; 3 men refused to have seminal analysis, 1 woman had unilateral tubal block on hysterosalpingogram and 1 required dilatation of a stenosed cervix early in the study. That infertility is a serious problem in Africa is shown by the large numbers of patients registering at the clinic during the study. 60% either became pregnant or had the cause of their infertility explained. The commonest causes of infertility were male factor (45%) and tubal damage (23% of those diagnosed). This is almost certainly explained by the high rates of genital infection, encouraged by prevailing sexual ethics and poor health facilities. Health education has an essential role to play in the prevention of fertility problems-- both in over and underfertility.
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PMID:Causes of infertility among 1000 patients in Ghana. 175 Aug 65

Sixty-six consecutive infertility clinic patients were prospectively screened with the 26-item Eating Attitudes Test and a study questionnaire. Women identified as being at high risk for an eating disorder were then interviewed to confirm or refute the diagnosis. A total of 7.6% of infertility clinic women were found to suffer from anorexia nervosa or bulimia nervosa. If eating disorders not otherwise specified were included, a total of 16.7% of infertility patients were found to suffer from an eating disorder. Among infertile women with amenorrhea or oligomenorrhea 58% had eating disorders. Because women often fail to disclose eating disorders to their gynecologists and may appear to be of normal weight, it is recommended that a nutritional and eating disorder history be taken in infertility patients, particularly those with menstrual abnormalities. It has previously been shown that disorder eating and nutrition can affect menstruation, fertility, maternal weight gain, and fetal well-being.
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PMID:Infertility and eating disorders. 195 95

Computerized tomography (CT) of the sella turcica was performed in 106 women with hypothalamic-hypophyseal-ovarian hypofunction, aged from 15 to 50 years. In each patient we evaluated tomographically hypophyseal volume and subarachnoid space cistern invaginated into the sella turcica. We analysed statistically the incidence of amenorrhea, infertility, obesity and arterial hypertension in five groups of patients classified according to hypophyseal volume i.e. from below 100 to over 400 mm3. Is was found that hypophyseal volume of women in the so-called empty sella turcica that could correlate significantly with obesity and arterial hypertension was up to about 200 mm3, and in case of amenorrhea and infertility below 100 mm3. In case of empty sella turcica in women with amenorrhea mean hypophyseal volume was significantly lower (about 194 mm3) than in menstruating women (about 248 mm3). Invagination of cisterns of the cerebral basis into the sella turcica equal to or exceeding three time hypophyseal volume in about 82% was associated with its small size i.e. below 150 mm3. Basing on our analysis it seem justified to assume that hypophyseal volume up to 150 mm3 is a CT criterion of diagnosing completely empty sella turcica.
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PMID:[Hypophysis volume in computerized tomography and clinical grounds for diagnosing a primary completely empty sella turcica]. 228 50

Lactational amenorrhea in many developing countries is still the most successful form of contraception, especially when modern forms of contraception are not available. In cultures where frequent or prolonged breast feeding is common, postpartum amenorrhea and suppressed ovulation are frequent and serve to space births. It is this spacing of births that leads to decreased infant and maternal morbidity and mortality. It must be remembered that lactational amenorrhea is not a completely reliable form of contraception. In fact the figures indicate that in cultures were family planning use is low, birth intervals are largely determined by the duration and intensity of breastfeeding. Studies indicate that an increase of 15% 32% in birth intervals can result from prolonged lactation. It would be to the advantage of health care planners and providers to examined more closely the causes and properties of lactational amenorrhea. Field directed education can provide women with the information necessary to help them control their child spacing. The WHO Breast-feeding Data Bank collects and analyzes information on breast-feeding and its effects on fertility regulation. Methods used to assess lactational infertility and how the information is used by the data bank are described in this article. There is a summary of relevant information gathered from published sources and post 1983 studies of the WHO. The practical implications to health policy that are associated with lactation-associated infertility are also mentioned.
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PMID:Breast-feeding and child-spacing: importance of information collection for public health policy. 228 98

The patient with androgen excess may present with amenorrhea, oligomenorrhea, painless metromenorrhagia, or infertility. Adrenal and ovarian tumors, though uncommon, must be excluded in the workup. The long-term sequelae of untreated anovulation includes adenomatous hyperplasia and cancer of the endometrium. Treatment can range from uncomplicated follow-up with cosmetic advice to the use of potent drugs that induce ovulation.
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PMID:Gynecologic problems of androgen excess. 235 85

Fertility and childbearing rarely occur in Cushing's syndrome because amenorrhea, oligomenorrhea, infertility, and abortions characterize the disease. Currently, a total of 53 cases of Cushing's syndrome and pregnancy have been reported. When Cushing's syndrome occurs during pregnancy, approximately 56 per cent of the cases are associated with adrenal cortical adenoma or carcinoma. Excluding Cushing's disease, nearly 21 percent of the cases are caused by adrenal carcinoma. The maternal catabolic state of glucocorticoid excess contributes to poor fetal outcome with many of the cases complicated by either fetal wastage or prematurity. However, congenital malformations are not seen more frequently than in normal pregnancy. Pregnancy may or may not influence Cushing's syndrome, but Cushing's syndrome definitely complicates pregnancy.
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PMID:Cushing's syndrome in pregnancy. 240 12

The pulsatile subcutaneous administration of human menopausal gonadotropin (hMG) or follicle-stimulating hormone (FSH) was used for induction of ovulation in 26 patients with hypothalamic/pituitary amenorrhea or polycystic ovary syndrome (PCO). Ovulation was observed in 116 (90.6%) of 128 treatment cycles, and 15 (16 treatment cycles) of 26 patients became pregnant. All 14 fetuses, excluding two pregnancies interrupted spontaneously at weeks 6 and 9, were singleton conceptions. Ovarian hyperstimulation was observed in 15.6% of treatment cycles. Five patients with PCO who failed to conceive on the hMG regimen also received pulsatile FSH administration. Although ovulation rates in PCO patients did not differ significantly between the hMG (88.1%) and FSH (88.2%) regimens, a significant reduction in the average dose of FSH (P less than 0.05) was observed with pulsatile FSH administration. Furthermore, the number of patients who conceived during the FSH regimen was significantly greater than that found with hMG treatment. The present data demonstrate that pulsatile subcutaneous administration of hMG or FSH is effective in induction of successful ovulation and establishment of singleton pregnancy in patients with various types of anovulatory infertility.
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PMID:Clinical experience in the induction of ovulation and pregnancy with pulsatile subcutaneous administration of human menopausal gonadotropin: a low incidence of multiple pregnancy. 249 2


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