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

The writer has always used a 12-month period before diagnosing secondary amenorrhea whereas a previously published article used a 4-month period. The spontaneous cure rate of amenorrhea of this short duration is relatively high. The writer has never claimed a causal relationship between oral contraceptives and secondary amenorrhea, but there is a high index of suspicion. Full investigation should be made, mainly to exclude pituitary tumor. In a recent series of patients with galactorrhea and amenorrhea, 20 of 25 with proved pituitary adenomas gave a history of oral contraceptive use. Clomiphene-responsive amenorrhea patients represent a heterogeneous group of disparate causes of anovulation and should not be grouped together. After 12 months or more of amenorrhea, patients followed-up for 18 months to 11 years still had a 30% persistence of the condition.
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PMID:Post-pill amenorrhoea. 58 35

Among 62 patients with galactorrhoea a corpus luteum deficiency or anovulatory cycles were found in 35 cases by serum progesterone determination, endometrial biopsy or basal body temperature records. 27 patients had a hyperpro-lactenemic amenorrhoea-galactorrhoea syndrome. During treatment with 2.5-5 mg. of Pravidel daily the basal body temperature was recorded, the concentrations of serum FSH, LH, Prolactin and progesterone were determined by radioimmunoassay. Other possible reasons for infertility were investigated. 10 of the 19 patients with normal serum prolactins in the group with deficient corpus luteum or anovulation became pregnant after a short duration of treatment, whereas only 2 of the 16 patients with hyperprolactenemia became pregnant. Among 27 patients with secondary amenorrhoea 11 became pregnant. All these patients had increased serum prolactins. During treatment with Pravidel all patients showed a significant increase of FSH and LH concentrations and a decrease of the prolactin concentrations. The outcome of the pregnancy of the 58 patients who became pregnant during treatment with Pravidel was also reported. 14 of the 58 pregnancies occured following additional treatment with Dyneric or HMG/HCG. Up to now there were 18 term deliveries following uneventful pregnancies. There were no fetal anomalies. The abortion rate was not higher than in the general population. All results show that euprolactinemia is not alone characterized by normal prolactin concentration. The clinical signs and symptoms of galactorrhoea without increase of prolactin over 20 ng/ml. in conjunction with ovarian dysfunction must be classified as dysprolactinemia.
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PMID:[Clinical experimental studies in the treatment of ovarian dysfunction with bromo-ergocryptin (pravidel) (author's transl)]. 68 May 50

A treatment plan utilizing placebo, cyclical steroid therapy, clomiphene citrate, and human pituitary gonadotropin is outlined for the induction of ovulation in carefully selected potentially fertile women. Such a plan minimizes any risk with the potentially hazardous ovulatory stimulants. A total of 220 patients with secondary amenorrhea were studied and an etiologic basis for the condition was found in 98 (45 per cent). Of the 220, 190 were found suitable for the induction of ovulation, and together with 145 patients with oligomenorrhea and 17 patients with anovulation, entered the treatment plan. Ovulation was successfully induced in 351 of the 352 (99.5 per cent) and pregnancy in 218 (61.9 per cent). The success rates for the agents in the various conditions are presented and discussed.
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PMID:The induction of ovulation. 77 94

Two hundred and fifty-five women received clomiphene citrate during a 10-year period. Fifty-six were treated diagnostically and one hundred and ninty-nine therapeutically for infertility. It is concluded that clomiphene may aid in confirming the diagnosis and establishing a prognosis in patients with primary or secondary amenorrhea. The success of clomiphene therapy in patients with anovulatory infertility is related to the etiologic factor responsible for the anovulation, but results can be improved by adjustment of the therapeutic regimen used. In the present series, 48% of the patients who ovulated became pregnant, and 25.3% of the pregnancies were miscarried. Those patients who ovulated spontaneously and became pregnant after having discontinued clomiphene therapy showed only a 10% abortion rate. A review of the results indicates that both the ovulation rate and the pregnancy rate can be improved if adjustments are made in therapy to ensure normal follicular maturation and corpus luteum function.
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PMID:The use of clomiphene citrate. 87 51

A group of 46 patients with secondary amenorrhea without galactorrhea or hyperprolactinemia were studied retrospectively after being clinically categorized into four groups with the use of progesterone-induced uterine bleeding and measurement of serum gonadotropins and prolactin levels. The ability to have regular spontaneous menstrual cycles and to conceive was assessed after a follow-up period of 10 years. Patients who had been classified as having hypothalamic pituitary "failure" (hypoestrogenic amenorrhea) with low levels of circulating estradiol had a greater rate of recovery of spontaneous ovulation and menses when compared with patients who had been classified as having only hypothalamic pituitary dysfunction (euestrogenic amenorrhea). The patients with diagnosis of hyperandrogenic chronic anovulation or polycystic ovary syndrome generally required clomiphene citrate for induction of ovulation and almost all the patients with premature ovarian failure (hypergonadotropic amenorrhea) remained estrogen-deficient and unable to ovulate. Hyperprolactinemia or an identifiable pituitary adenoma has not developed in any of the patients to date.
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PMID:Ten-year follow-up of patients with secondary amenorrhea and normal prolactin. 204 15

The results of ovulation induction in patients with ovulatory dysfunction were reviewed for a one year period. Eighty-six women were assigned to four groups: secondary amenorrhea, anovulation, oligo-ovulation, and luteal phase defect/short luteal phase (LPD). All patients were monitored with basal body temperature (BBT) graph, postcoital testing, and ultrasonic scanning of ovarian follicles. All patients received therapy with clomiphene citrate (CC) for a minimum of four cycles and 13 patients conceived. Fifty patients were offered additional therapy with human menopausal gonadotropins (HMG-HCG). Seventeen completed a minimum of four cycles, and 13 conceived. The number of CC-treated patients with poor mucus quality in the face of adequate follicular development was 24, or 48%. The overwhelming problem with ovulation induction when CC failed was the large number of patients who dropped out of therapy, 48%. In summary, close monitoring during ovulation induction to confirm ovulation, and assess mucus quality and luteal function allow detection and correction of inadequate response. Induction of ovulation can be highly successful if patients can follow through and complete protocols of therapy.
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PMID:Methods of ovulation induction. 210 29

In order to analyse the role of hypercarotenemia in amenorrhoea, we have studied the ovarian function of 20 patients presenting with hypercarotenemia (serum carotene greater than 5 mumol/l). 12 of these were complaining of secondary amenorrhoea (group I), 7 with a normal weight (group I A) and 5 with a weight below 85% of ideal weight (group I B). Another group of 8 patients had normal menstrual cycles and a body weight within normal limits (group II). Group I presented an ovarian insufficiency of hypothalamic origin with an increase in the FSH/LH ratio. The patients in group I A although of normal weight differed from group II by a history of important weight variations, strenuous sports activity and an essentially vegetarian diet, the most likely reason for their hypercarotenemia. The high carotene levels however do not seem to be directly responsible for the amenorrhoea, in view of the normal menstrual cycles of the patients in group II. Hypercarotenemia can be considered as a biologic marker of weight loss with fat mobilisation and low T3 levels. It can also be due to a vegetarian diet. The latter may be an aetiological factor in anovulation by increasing faecal excretion of oestrogens and thus decreasing blood levels of oestradiol particularly when associated with other compounding factors such as excessive physical activity, loss of weight or affective problems.
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PMID:[Hypercarotenemia, amenorrhea and a vegetarian diet]. 234 71

The enormous increase in participation by women in physical recreation and sport since the early 1970s, has seen a parallel increase in research into the effects of strenuous exercise on the female neuroendocrine and reproductive systems. Oligomenorrhoea, primary or secondary amenorrhoea, altered pubertal progression, defective luteal phase, anovulation, and infertility may result, most frequently in those aerobic type activities associated with the lower bodyweight and fat percentages such as running, aerobics, and gymnastics. As well as body composition and sport specificity, intensity of training, previous menstrual history (in particular delayed menarche) and diet/eating disorders are all important associated factors. The neuroendocrinological pathogenesis to this altered menstrual function is complex and controversial; however, the evidence for accelerated bone loss in these young women with chronic hypo-oestrogenaemia is substantial. Since the first studies released in 1982 when amenorrhoeic runners' bone mineral content was measured and found equivalent to that predicted normal for 52-year-old women, further studies have proposed an association between this hypo-oestrogenaemia, reduced bone density and stress fractures. Studies so far show that this bone loss continues to occur over time, but the most rapid rate of bone loss (approximately 4%/year) occurs early on cessation of menses, thus emphasising the importance of early management in preventing bone loss occurring in young amenorrhoeic athletes. The role of calcium and oestrogen supplementation in management of the hypo-oestrogenic exercising female are unclear. The results of longitudinal studies currently under way assessing their benefits are awaited. Meanwhile an increased calcium intake to 1500mg per day should be advised and consideration of oestrogen and/or progesterone supplementation given. It is important that other causes of amenorrhoea are not overlooked in this exercising population and the diagnosis of 'athletic amenorrhoea' should not be made until a full thorough history, physical examination and blood tests have eliminated other common causes. Full dietary history and assessment for eating disorders is an essential part of this assessment.
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PMID:Athletic amenorrhoea. An update on aetiology, complications and management. 264 73

Pulsatile intravenous gonadotropin releasing hormone (IV-GnRH) was used in 36 infertile patients with primary amenorrhea (n = 5), secondary amenorrhea due to hypothalamic chronic anovulation (HCA) (n = 22), hyperprolactinemia (n = 1) or polycystic ovary syndrome (PCOS) (n = 5), and oligomenorrhea (n = 3), using several dosage and timing regimens. Early follicular phase responses showed four patterns: type 1 consisted of a delayed follicle-stimulating hormone (FSH) peak and was seen with severe hypothalamic suppression (n = 4); type 2 consisted of a brisk and dominant FSH peak on the first day of treatment, and occurred with mild to moderate hypothalamic suppression (n = 19); type 3, which consisted of an FSH peak accompanied by an immediate and exaggerated luteinizing hormone (LH) rise, occurred with mild PCOS and some cases of HCA (n = 5); and type 4, in which LH levels were high to begin with and neither FSH nor LH levels rose with GnRH, occurred with severe PCOS (n = 2). Exaggerated estradiol responses within 24 hours of therapy were seen in eight cycles: in four cases no ovarian abnormality was apparent; in three cases a dominant follicle was already present; and in one case ovarian hyperstimulation was diagnosed ultrasonographically. With standard human chorionic gonadotropin luteal phase support, luteal phase defects were rare with HCA but common with PCOS.
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PMID:Pulsatile intravenous gonadotropin-releasing hormone for ovulation-induction in infertile women. II. Analysis of follicular and luteal phase responses. 310 64

Pulsatile intravenous gonadotropin-releasing hormone (IV-GnRH) was used in 36 infertile patients with primary amenorrhea (n = 5), secondary amenorrhea due to hypothalamic chronic anovulation (HCA) (n = 22), hyperprolactinemia (n = 1) or polycystic ovary syndrome (PCOS) (n = 5), and oligomenorrhea (n = 3). Treatment was commonly initiated in the hospital but was then continued outside, with patients and local physicians accepting responsibility for maintaining IV-GnRH delivery systems. Twenty-eight of 113 treatment cycles (24.8%) resulted in pregnancy, with four spontaneous abortions (14.3%) and four twin pregnancies (16.7%) among 24 births. Probability of pregnancy per treatment cycle was significantly higher for primary amenorrhea (0.30) and for HCA (0.33) than for PCOS (0.07; P less than 0.05) and for oligomenorrhea (no conceptions; P = 0.01). Ovulatory cycles were not achieved in five patients (primary amenorrhea, n = 1; PCOS, n = 3; oligomenorrhea, n = 1). There were no serious complications; six patients recorded eight febrile episodes, which responded quickly to antibiotic therapy and cannula change. The authors conclude that outpatient IV-GnRH is safe, practical, and effective for follicular stimulation and ovulation induction in women presumed to have GnRH deficiency and in whom clomiphene therapy fails, and that less intensive monitoring is needed compared with gonadotropin ovulation induction therapy.
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PMID:Pulsatile intravenous gonadotropin-releasing hormone for ovulation-induction in infertile women. I. Safety and effectiveness with outpatient therapy. 329 12


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