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Query: UMLS:C0003128 (anovulation)
 1,718 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Endometrial carcinoma is the most frequent malignancy of the female reproductive tract, and irregular vaginal bleeding is its most common symptom. It is most common among postmenopausal women and is associated with obesity, nulliparity, and anovulation. Oral contraceptive (OC) use and tobacco smoking have been reported to protect against it. A 30-year-old nulligravida nulliparous woman presented with menometrorrhagia. She had had normal menses since age 11, she had smoked a pack of cigarettes a day for 15 years, and had been obese since age 15 (weighing 302 pounds). At age 26, she started taking a combination OC containing .1 mg ethynodiol diacetate and 35 mcg ethynyl estradiol (EE). 4 years later she gradually developed menorrhagia which improved upon changing the OC to .3 mg norgestrel and 30 mcg EE. Subsequently she developed early cycle metrorrhagia and was placed on .5 mg norgestrel and 50 mcg EE. She continued having early and midcycle breakthrough bleeding with clots. Physical examination and test results including a PAP smear were normal. She was taken to the emergency department because of continued bleeding. The uterus sounded to 14 cm. Curettings were consistent with grade 1-2, well-differentiated adenocarcinoma of the endometrium. 3 weeks later, she had total abdominal hysterectomy, bilateral salpingo-oophorectomy, and peritoneal biopsy for cytological examination. The pelvis and the abdomen were free of metastasis. Histological examination revealed a superficially invasive, well-differentiated adenocarcinoma consistent with stage IB, grade 1%. Ploidy analysis uncovered 12.5% tetraploid, with 0% aneuploid or hyperploid cells with 8.5% of the cells in S phase and 21% in the proliferative phase. Both estrogen and progesterone receptors were positive. The ploidy analysis and receptor status were consistent with the low-grade nature of the lesions. Postoperative radiation was not recommended, and the patient was well 6 months postoperatively.
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PMID:Menometrorrhagia in an oral contraceptive user. 842 44

An accurate, efficient diagnosis of disorders responsible for abnormal uterine bleeding depends on a systematic consideration of all the possible causes. Careful history and physical and pelvic examinations provide the framework for evaluation. Many adjunctive diagnostic aids can be used to evaluate women with abnormal uterine bleeding. These tests include complete blood cell count, pregnancy test, hormone levels (estradiol, progesterone, follicle-stimulating hormone, luteinizing hormone, prolactin, testosterone, dehydroepiandrosterone sulfate), thyroid function tests, liver function tests, and coagulation profile. The need for these tests are individualized and based primarily on the patient's presentation. In women of reproductive age a complication of pregnancy should always be ruled out. Ectopic pregnancies can be life threatening. The prognosis in women with trophoblastic disease can be altered by a delay in establishing the correct diagnosis. Ultrasonographic studies, particularly transvaginal ultrasonography and hysteroscopy, have played an increasing role in the evaluation of patients with abnormal uterine bleeding over the past decade, especially for cases of intrauterine space-occupying lesions, including endometrial polyps, submucosal myomas, and retained placental fragments. Suspicion of reproductive tract malignancies is heightened in patients > 35 years old, those with a history of oligoovulation or anovulation suggestive of long-term unopposed estrogen exposure, those who are obese, and those who do not respond to first-line medical management. Diagnostic techniques available for the evaluation of these cases include endometrial biopsy, dilatation and curettage, transvaginal ultrasonography, and hysteroscopy. These procedures not only allow accurate diagnosis but may permit immediate therapeutic measures to be taken when organic causes are discovered. In summary, the key to the evaluation of abnormal uterine bleeding is a through history and physical and pelvic examinations governed by the differential diagnosis of excessive uterine bleeding and the selected use of adjunctive diagnostic tests and procedures only when absolutely necessary.
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PMID:Evaluation of patients with abnormal uterine bleeding. 882 62

Infertility has been suggested as a risk factor for various gynaecological cancers. Data analyses show that among infertile women, those with anovulation or polycystic ovarian syndrome (PCOS) have an increased risk of cancer. Clinical and laboratory data such as anthropometric measurements, endogenous hormones and growth factors may explain mechanisms which link tumorogenesis or tumour promotion to infertility. The possible association between ovulation induction and cancer is discussed both on theoretical grounds and based on epidemiological data. We conclude that according to epidemiological studies, laboratory data and on theoretical grounds, infertile patients have an increased lifetime risk of gynaecological cancer. The risk of cancer should be evaluated further for each subpopulation of infertile patients. Thus, more adequate means of monitoring these patients will become available. These data are necessary for a further evaluation of the possible cancer risks of infertility treatments.
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PMID:The link between female infertility and cancer: epidemiology and possible aetiologies. 907 4

Menorrhagia--menstrual periods lasting longer than 7 days and totaling blood losses greater than 80mL--affects 9%-14% of otherwise healthy women, and it can signal cancer, an endocrinologic disorder, or gynecologic disease. Blood loss can be high enough to result in anemia, fatigue, and syncope. Most often, abnormal uterine bleeding such as menorrhagia involves a disruption in the hypothalamic-pituitary axis, the ovary, and/or the uterus. Other identified causes include medications (especially psychotropics) that cross the blood-brain barrier; chronic diseases such as cancer, diabetes, and liver and kidney dysfunction; endocrine disorders, perimenopausal anovulation, polycystic ovary disease, pituitary tumors, and abnormal estrogen cycling caused by morbid obesity; and anatomic abnormalities of the uterus. Routine tests include hematocrit or hemoglobin to detect and evaluate anemia, thyroid stimulating hormone (TSH) level to evaluate thyroid function as a possible cause, and a pregnancy test to rule out an incomplete, spontaneous abortion as a cause. A Pap test is recommended to screen for dysplasia that can suggest a gynecologic cancer cause. Additional screening for endocrine disorders that may be causing menorrhagia include tests of thyroid, liver, and kidney function, and tests of follicle stimulating hormone (FSH), prolactin, and cortisol levels. Treatment can be medical or surgical. Medical treatment includes prostaglandin inhibitors, specifically nonsteroidal antiinflammatory drugs (NSAIDs), and hormonal therapy with estrogen, progesterone, gonadotropin-releasing hormone agonists, or oral contraceptives such as medroxyprogesterone (Depo-Provera). Surgical treatment includes hysteroscopic endometrial ablation by physical agents, laser electrodiathermy, and "roller ball," or surgical, resection. Hysterectomy is the treatment of last resort.
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PMID:Treatment Decisions in the Management of Menorrhagia. 974 72

Anorexia nervosa is a complex psychiatric disorder with endocrinologic manifestations primarily affecting adolescent females. The classic triad of presenting symptoms is weight loss in excess of 15% of ideal body weight, behavioral changes and amenorrhea (secondary or primary). The menstrual irregularities may cause the patient or family to seek gynecologic consultation before the diagnosis of primary psychiatric disorder has been made. Bulimia is a separate disease entity characterized by compulsive overeating binges followed by compensatory purging behavior to maintain a desired weight. Depending on the degree of psychiatric disturbance, purging, and ultimate body weight, such patients may or may not present with menstrual abnormalities. Hypoestrogenic hypothalamic amenorrhea in both types of patients may result in osteoporosis, stress fractures, and infertility. Obese women, in contrast to the above, most often have abnormally heavy bleeding patterns secondary to chronic anovulation. Their-short term gynecologic concerns may be cycle control or infertility, but over the long term they are at increased risk for endometrial hyperplasia and cancer.
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PMID:Managing adolescents with eating disorders. 1043 10

This report presents the development of endometrial adenocarcinoma after diagnosis of polycystic ovary syndrome (PCOS) in three premenopausal women. Such cases illustrate the increased potential for endometrial hyperplasia and malignancy in the setting of chronic anovulation associated with PCOS and underscore the need for prompt identification and treatment. Attention to endometrial thickness (as measured by transvaginal sonogram) and elevated insulin level (as measured by fasting plasma insulin) can improve clinical surveillance of both conditions and preserve reproductive potential for women with PCOS.
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PMID:Endometrial adenocarcinoma and polycystic ovary syndrome: risk factors, management, and prognosis. 1137 9

African-American women have a long-standing approximately 20% higher breast cancer incidence rate than USA White women under age 40 while rates among Latinas are lower than those of Whites. The reasons for this are not clear, however they may be due to ethnic differences in circulating oestradiol and progesterone levels. In a cross-sectional study, we investigated whether anovulation frequency and circulating serum oestradiol and/or progesterone levels vary among normally cycling nulliparous African-American (n=60), Latina (n=112) and non-Latina White (n=69) women. Blood and urine specimens were collected over two menstrual cycles among healthy 17- to 34-year-old women. Frequency of anovulation was greater among White women (nine out of 63, 14.3%) than African-American women (four out of 56, 7.1%) or Latina women (seven out of 102, 6.9%), although these differences were not statistically significant. African-American women had 9.9% (P=0.26) higher follicular phase oestradiol concentrations than Latina women and 17.4% (P=0.13) higher levels than White women. African-American women also had considerably higher levels of luteal phase oestradiol (vs Latinas, +9.4%, P=0.14; vs Whites, +25.3%, P=0.003) and progesterone (vs Latinas, +15.4%, P=0.07; vs Whites, +36.4%, P=0.002). Latina women were also observed to have higher follicular oestradiol, and luteal oestradiol and progesterone levels than White women (follicular oestradiol: +6.8%, P=0.48; luteal oestradiol: +14.6%, P=0.04; luteal progesterone: +18.2%, P=0.06). These results suggest that exposure to endogenous steroid hormones may be greater for young African-American and Latina women than for Whites.
Br J Cancer 2002 Feb 01
PMID:Ethnic differences in ovulatory function in nulliparous women. 1187 1

The risks of steroidal contraception as reviewed by the Central Medical Committee of the International Planned Parenthood Federation in April 1970 are presented and discussed. The causal relationship between the use of steroidal contraceptives and thromboembolic disease is accepted, but the complication is considered very rare. It is recommended that oral formulations containing less than 50 micrograms of estrogen be used wherever possible, but for those women who need a higher estrogen content, it is still responsible to prescribe it. No adequate evidence has been obtained linking steroidal contraception in any relationship with cancer or fetal abnormalities. Estrogen administration possibly produces an adverse change in the quantity and quality of milk and the duration of lactation. Rare cases of jaundice and hypertension appear to be sometimes associated with oral contraceptive use and are easily reversible. Changes in glucose tolerance and serum lipids appear to occur under steroidal administration and are reversible. It is possible that those women with a history of irregular menstruation prior to taking the pill may experience prolonged anovulation after ceasing pill use. Mental changes reported due to oral contraceptives are highly subjective in nature and difficult to evaluate. It is concluded that the pill is highly effective as a method of family planning and is a significant factor in world health presenting no risks that justify discontinuation of its use.
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PMID:Use of steroidal contraception justified. 1225 54

The pathogenesis of breast cancer is Extensive tests isolate 3 distinct factors: genetic, hormonal and viral. Thus, the risk factor is increased 2-3 times by hereditary predisposition whereas (bilateral) ovariectomy, blocking production of ovarian hormones, reduces the risk by 10 times. Childbirth reduces the risk in reverse proportion to its frequency; however, less protection is afforded if not accompanied by lactation. Nulliparity was recognized as a risk factor in 1926, but recent studies have proven less conclusive. Also included as risk factors are the intake of fatty nutrients and obesity. Further indications include older age at 1st pregnancy, menstrual disorders, and a prolonged reproductive life as a result of precocious menarche and/or delayed menopause. The longer menopause is delayed, the greater the premenopausal period characterized by hyperestrinization, anovulation, and a modest production of progesterone. Metabolism of estrogens oriented towards more active metabolites compounds the risk factors. It has been impossible to verify an etiologic connection between estrogenic preparations administered during post-menopause and breast cancer. Oral contraceptives, in general, do not seem to pose any risk. A connection between prolactin and cancer has been demonstrated in rodents, but not in humans. Antiprolactin pharmaceuticals are capable of inducing regression of neoplasia, indicating a plausible, however unproven, active role of prolactin. Progesterone acting as an antiestrogen reduces the levels of cytoplasmic receptors, thus probably acting protectively. Basically, two approaches are possible for endocrine treatment of metastasized breast carcinoma: ablative surgery based on hormone deprivation (ovariectomy, suprarenalectomy, hypophysectomy) or additive therapy based on hormonal interference (estrogens, androgens, progestins, antiestrogens).
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PMID:[Hormonodependence and hormonosensibility of the gynecological neoplasias. III. The breast carcinoma]. 1228 88

Endometrial cancer is a disease of the affluent, developed world, where epidemiological studies have shown that > or =40% of its incidence can be attributed to excess body weight. An additional proportion may be because of lack of physical activity. Alterations in endogenous hormone metabolism may provide the main links between endometrial cancer risk, and excess body weight and physical inactivity. Epidemiological studies have shown increased endometrial cancer risks among pre- and postmenopausal women who have elevated plasma androstenedione and testosterone, and among postmenopausal women who have increased levels of estrone and estradiol. Furthermore, there is evidence that chronic hyperinsulinemia is a risk factor. These relationships can all be interpreted in the light of the "unopposed estrogen" hypothesis, which proposes that endometrial cancer may develop as a result of the mitogenic effects of estrogens, when these are insufficiently counterbalanced by progesterone. In our overall synthesis, we conclude that development of ovarian hyperandrogenism may be a central mechanism relating nutritional lifestyle factors to endometrial cancer risk. In premenopausal women, ovarian hyperandrogenism likely increases risk by inducing chronic anovulation and progesterone deficiency. After the menopause, when progesterone synthesis has ceased altogether, excess weight may continue increasing risk through elevated plasma levels of androgen precursors, increasing estrogen levels through the aromatization of the androgens in adipose tissue. The ovarian androgen excess may be because of an interaction between obesity-related, chronic hyperinsulinemia with genetic factors predisposing to the development of ovarian hyperandrogenism.
Cancer Epidemiol Biomarkers Prev 2002 Dec
PMID:Obesity, endogenous hormones, and endometrial cancer risk: a synthetic review. 1249 40


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