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

There are several possible causes for amenorrhea. Two of the most common are mental anorexia and psychological shock. To perform laparoscopy in such cases would be of limited effect. Laparoscopy is useful in patients with ovarian hyperandrogenia. The cases for which laparoscopy is indicated are listed and explained. Laparoscopy helps explain luteal insufficiency which provoke infertility. However, one should not try to multiply the indications of this procedures.
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PMID:[Ovaries and Laparoscopy]. 1226 Jul 86

A brief review of the literature is the basis for this discussion of residual effects of oral contraceptives (OCs) on fertility and the quality of ovulation after pill use is terminated. A 1982 study of the delay to conception attempted to avoid methological difficulties of earlier studies by comparing previous contraceptive usage among 7000 women hospitalized for childbirth. The analysis showed that the monthly percentage of pregnancies after OC use was significantly decreased for the 1st 3 months compared to levels in former IUD and diaphragm users. 13 months after OCs, 24.8% of OC users still had not conceived, compared to 12.4% if IUD and 8.5% of diaphragm users. Post-pill amenorrhea of longer than 6 months occurs in about 1% of cases. It is now agreed that post-pill amenorrhea is rare, nonspecific, and of multifactorial etiology. The previous existence of menstrual irregularity, stress, psychological troubles, malnutrition, and anorexia are particularly significant. OC use seems to mask the natural occurrence of secondary amenorrhea rather than to cause it. The most careful of available studies document that, although OC use may because of its estrogen content reveal an unsuspected prolactinemia, there is no increase in prolactinemia among OC users. A consensus exists that, excluding patients developing amenorrhea due to ovarian insufficiency, post-pill amenorrhea responds to ovulation inducing treatment exactly as do amenorrheas with no history of pill use. In cases of conception after failure of OCs and continued treatment with OCs, the aging of sperm or hypermaturation of ova at the time of fertilization is accompanied by a very slight increase in the proportion of male fetuses. The teratogenic risk appears to be negligable among former OC users and perhaps slightly greater if OCs, hormonal tests, or supplementary hormonal therapy are continued during pregnancy. The increased risk is not even seen in many studies and does not appear to indicate pregnancy termination as a general rule.
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PMID:[Fertility and characteristics of ovulation after discontinuing oral contraception]. 1226 9

Anorexia nervosa is an eating disorder defined by a symptomatic triad, anorexia, emaciation and amenorrhoea. This disease mainly affects young women. Besides these three symptoms, hyperactivity is often associated with anorexia nervosa. Hyperactivity can be considered as a strategy to lose weight, but studies on animal models have shown that it could be explained by more complicated mechanisms. Hyperactivity is defined by an excess of physical activity, which can induce social, professional and family consequences. Hyperactivity can take different forms, most striking is the restless one. Patients with anorexia nervosa are not all hyperactive. Brewerton et al. have compared patients with anorexia nervosa and hyperactivity to patients without hyperactivity. Hyperactive patients are more dissatisfied by their body image, they use less means of purging (laxatives, vomiting), and they start starving earlier than patients without hyperactivity. Many factors can promote the emergence and maintenance of hyperactivity, especially social and cultural requirements, sports environment, family influences. Various models can explain the links between excessive exercise and anorexia nervosa. Epling and Pierce have exposed a behavioural model which shows how hyperactivity can lead to starvation, creating a self-maintained cycle. Eisler and Le Grande have described four models to explain the links between hyperactivity and anorexia nervosa. First, excessive exercise can be considered as a symptom of anorexia nervosa. It can also promote the development of eating disorders. Anorexia nervosa and hyperactivity can be a manifestation of an other psychiatric disorder. At least, hyperactivity can be a variant of anorexia nervosa, which has the same effects, as weight loss. Hyperactivity can also be considered as a kind of obsessive compulsive disorder. Hyperactivity and obsessive compulsive disorders actually share some clinical and neurochemical characteristics. An other model consists in comparing excessive exercise in anorexia nervosa to an addictive behaviour. Self-starvation exacerbated by hyperactivity can be considered as an addiction to endogenous opioid. Few studies are carried out in order to estimate the prevalence of high level exercise in the eating disorders. Davis et al. have achieved a prevalence study. The results indicate that a large majority of patients with anorexia nervosa (80,8%) were exercising excessively during an acute phase of the disorder. Research on animals, specially on rats, brings us an interesting model explaining interactions between anorexia nervosa and hyperactivity. With animal models, we have noticed that, when rats with access to a running wheel, are restricted in their food intake, they become excessively active, and paradoxically reduce food consumption. Many searchers have tried to explain this phenomenon. Morse et al. have pointed from animal models that the level of hyperactivity was linked to the severity of food restriction. This result can be explained by a failure of a part of the brain involved in rest and activity regulation. Animal research brings us explanations about the effects of starvation on the endocrine system and the neurotransmitters. Broocks et al. have shown that corticosterone concentration in plasma was synergistically increased by semi starvation and exercise, and the reduction of triiodothyronine by semi starvation was significantly greater in the running wheel group. An other study of Broocks et al. has revealed an increased hypothalamic serotonin metabolism with the combined effect of hyperactivity and food restriction. Tryptophan, an amid acid involved in serotonin synthesis, can also play a role in the maintenance of anorexia nervosa. In starvation conditions, opioid releasing caused by physical exercise would decrease food intake. Exner's study and Adan's one have shown that leptin would be involved in semi starvation induced hyperactivity mechanisms. In spite of animal models can not be entirely generalized to human, they are useful to try to explain biological supports of hyperactivity. Hyperactivity is not only a strategy to lose weight, but also a specific symptom which completes the clinical triad. Animal studies have led to promising results; we might use medicine, such as serotonin reuptake inhibitors or opioid antagonists in the treatment of hyperactivity in anorexia nervosa.
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PMID:[Hyperactivity and anorexia nervosa: behavioural and biological perspective]. 1562 53

Anorexia nervosa is an eating disorder, characterized by low body weight, distorted body image, amenorrhea and an intense fear of gaining weight. The occurrence of anorexia nervosa has increased over the past 10 years among adolescents and young women and it is estimated to occur in 0,5-1% of population. The Anorexia nervosa is not only a psychiatric illness may have many serious gynecological and medical ramifications. Preventive measures to reduce the incidence of anorexia are not known at this time. However, early detection, intervention and cooperation between many specialists can reduce the severity of symptoms and health consequences. Gynecologists assume a broader role in preventative medicine and health maintenance, that is why their awareness of anorexia nervosa is needed. Anorectic patients have metabolic and endocrine complications. Most of them are caused by the dysfunction of hypothalamus, which produces many nueropeptides and neurotransmitters. Anorexia nervosa is characterized by numerous aberrations in neuropeptides and neurotransmitters, such as gonadotropin-releasing hormone, corticotropin-releasing hormone, neuropeptyd Y, leptin, beta-endorfins and serotonine, dopamine. The relationship of anorexia nervosa with genetic factor is being enhanced lower the last few years. However, the studies on the role of polymorphism in some genes brought conflicting results.
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PMID:[Anorexia nervosa--new view on neuroendocrine and genetic determinations]. 1707 96

Menstrual dysfunction is very common in female athletes, with close to 40-60% of freshman college athletes giving a history of menstrual irregularity. Pathogenic eating behavior is also very common in female athletes, and these numbers appear to be on the rise. Both of these disturbances have established morbidity, and eating disorders have a mortality rate as high as 18%. Both anorexia and amenorrhea have also been associated with decreased bone mineral density. For the young athlete, low bone mineral density may put them at increased risk for stress fractures. There may also be a long-term risk for premature osteoporosis. Disordered eating, menstrual dysfunction, and osteoporosis have become known together as the "female athlete triad." This discussion will discuss these clinical entities, and methods to recognize and treat them. If these abnormalities are sought out and education is provided to the young female athlete, the hope is that these entities can be detected early on and the complications of the triad can be prevented.
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PMID:Female athlete triad. 1763 May 19

Anorexia nervosa is diagnosed by drastic weight loss, a fear of gaining weight, a distorted body image, and, in women, three consecutive episodes of amenorrhea. It is often associated with a compulsive need for exercise, a bright outlook on life, and a high level of competitiveness. It afflicts primarily young women in higher socioeconomic strata who are highly competitive and otherwise overachievers. There are three adaptive explanations for anorexia nervosa: the reproductive suppression, the fleeing famine and the pseudo-female hypotheses. Here I present a novel hypothesis, the age-related obesity hypothesis. It posits that the otherwise normal tendency by women to seek a youthful appearance can become maladaptive and lead to anorexia nervosa in environments in which thinness becomes the primary indicator of youth, such as in modern industrialized societies. This hypothesis explains the aforementioned associated features of anorexia nervosa, and its increasing prevalence in western societies. The hypothesis generates several testable predictions: (1) Prevalence of anorexia nervosa across societies should be related to the degree to which thinness is an indicator of youth in a population. (2) Conversely, perceptions of the weight-age relationship should differ among populations depending on the prevalence of anorexia nervosa. (3) Anorectic individuals, or those with the propensity to develop the disease, should have a biased perception of the weight-age relationship. (4) Experimental manipulation of individuals' perception of the weight-age relationship should affect weight concerns, particularly among anorectic or at-risk individuals. Should the hypothesis be supported it might be used to screen at-risk individuals. Furthermore, it would call for more integrative public health programs that take a comprehensive approach encompassing both obesity and anorexia.
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PMID:Obesity and sexually selected anorexia nervosa. 1911 96

The practitioner, as well as specialist such as gynecologist and endocrinologist, may face in their office women with eating disorders, abnormalities of menstrual cycles and low bone mass, which may be the first hints of the female athlete triad. In these situations, the practitioner may search other findings of these triad by looking at some particular physical findings and by using appropriate questionnaire. In some advanced forms of this triad specific abnormalities of eating disorders (anorexia and boulimia) may be present as well as amenorrhea and osteoporosis, which may disturb the well-being and cause health damages of women practising sport either as amateur or in a elite setting. An appropriate handling of such disorders has to be proposed to these women.
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PMID:[Female athlete triad]. 1972 50

Menstrual cycle irregularities are often observed among physically active women and athletes who participate in physical activity ranging from recreational to competitive exercise training. Further, such irregularities have been casually linked to an energy deficiency where caloric intake is inadequate for exercise energy expenditure resulting in a suppressive effect on growth and reproduction. Adaptations consistent with chronic energy deficiency, including reductions in resting energy expenditure and total triiodothyronine, have been observed in exercising women with functional hypothalamic amenorrhea (FHA). Gut peptides and adipocytokines also appear to be altered in exercising women with FHA and have been hypothesized to be involved in the etiology of FHA. Ghrelin concentrations are elevated in exercising women with FHA. Interestingly, while fasting ghrelin, an orexigenic peptide, is elevated in women with FHA, PYY, an orexigenic peptide, is paradoxically also elevated in women with anorexia nervosa and exercising women with FHA. Leptin, an adipocytokine, is also suppressed in FHA associated with exercise and anorexia. A critical leptin concentration threshold is suggested to be necessary for regular menses to occur. Ghrelin, PYY, and leptin all have the ability to cross the blood brain barrier and, in the hypothalamus, can modulate appetite and food intake, and are hypothesized to affect the hypothalamic-pituitary-ovarian axis. Future studies are needed to determine if ghrelin, PYY, or leptin play a direct role in the regulation of the hypothalamic-pituitary-ovarian axis, and if these signals can be altered by improving energy status secondary to increasing caloric intake and initiate the reversal of amenorrhea.
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PMID:Menstrual irregularities and energy deficiency in physically active women: the role of ghrelin, PYY and adipocytokines. 2095 62

Current classification of eating disorders is failing to classify most clinical presentations; ignores continuities between child, adolescent and adult manifestations; and requires frequent changes of diagnosis to accommodate the natural course of these disorders. The classification is divorced from clinical practice, and investigators of clinical trials have felt compelled to introduce unsystematic modifications. Classification of feeding and eating disorders in ICD-11 requires substantial changes to remediate the shortcomings. We review evidence on the developmental and cross-cultural differences and continuities, course and distinctive features of feeding and eating disorders. We make the following recommendations: a) feeding and eating disorders should be merged into a single grouping with categories applicable across age groups; b) the category of anorexia nervosa should be broadened through dropping the requirement for amenorrhoea, extending the weight criterion to any significant underweight, and extending the cognitive criterion to include developmentally and culturally relevant presentations; c) a severity qualifier "with dangerously low body weight" should distinguish the severe cases of anorexia nervosa that carry the riskiest prognosis; d) bulimia nervosa should be extended to include subjective binge eating; e) binge eating disorder should be included as a specific category defined by subjective or objective binge eating in the absence of regular compensatory behaviour; f) combined eating disorder should classify subjects who sequentially or concurrently fulfil criteria for both anorexia and bulimia nervosa; g) avoidant/restrictive food intake disorder should classify restricted food intake in children or adults that is not accompanied by body weight and shape related psychopathology; h) a uniform minimum duration criterion of four weeks should apply.
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PMID:Classification of feeding and eating disorders: review of evidence and proposals for ICD-11. 2265 33

Anorexia nervosa (AN) is a chronic psychiatric disorder with a high prevalence of 0.6% and the highest mortality rates among psychiatric diseases, around 10%, mostly due to undernutrition and suicide. AN is characterized by physiological features with a body mass index less than 17.5 kg/m(2), low bone mineral density and amenorrhea, psychological symptoms with a distortion of image body, and behavioral abnormalities. Estrogen molecules and estrogen biological pathway are clearly involved in food intake and body weight in animals and humans. Further, hypoestrogenism has been demonstrated in AN patients and convergent evidence involves the estrogen pathway in the development of AN. AN presents a high heritability and polymorphisms in genes coding the estrogen receptors alpha and beta have been found significantly associated with the disorder. This chapter shows the implication of estrogens in AN and suggests investigation to develop future pharmacological treatments for anorexia.
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PMID:Anorexia nervosa and estrogen receptors. 2360 24


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