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

This study evaluated the etiologic factors in 262 patients with adult-onset amenorrhea. Criteria for inclusion into the study included secondary amenorrhea of 6 months duration or more that was preceded by at least 6 menses after menarche and occurred before age 39 years. The average age of presentation in this series was 26.4 years. The 4 most common causes of amenorrhea were hypothalamic suppression (33.5%), chronic estrogenic anovulation (28%), hyperprolactinemia (14%), and ovarian failure (12%). This pattern contrasts with findings in an earlier study of women with pubertal amenorrhea in which the most common etiologies were ovarian failure (43%), congenital absence of the uterus and vagina (15%), and physiologic delay of puberty (14%). The data provide support for the common practice of obtaining a serum prolactin determination in women with amenorrhea. 54% of patients were hypogonadal on presentation while 46% were eugonadal. Amenorrhea after use of oral contraceptives (OCs) was found in 77 (29%) of cases, the majority of whom had normal cycles before OC use. It is suggested that OC users of reduced body weight may be at increased risk of postpill amenorrhea if they significantly reduce caloric intake during OC use to avoid the side effect of weight gain. It is further suggested that longterm OC use may stimulate galactoroph hyperplasia. In the present series, 48% of all patients with hyperprolactinemia had postpill amenorrhea and 17% of women with postpill amenorrhea were hyperprolactinemic. Analysis of morbidity data indicated that adult-onset amenorrhea presents less significant detrimental effects on the quality of life, including fertility, than pubertal amenorrhea. However, early diagnosis, treatment, and counseling remain essential for all patients.
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PMID:Adult-onset amenorrhea: a study of 262 patients. 352 65

Five patients with hyperprolactinaemic amenorrhoea who had been resistant to, or intolerant of bromocriptine were treated with pulsatile LHRH therapy. Ovulation was induced in 9 of 12 treatment cycles. In one patient hyperstimulation occurred in the first cycle of treatment but subsequently she ovulated normally on a reduced dose of LHRH. The gonadotrophin and ovarian responses to treatment in ovulatory cycles were normal despite prolactin concentrations that remained elevated throughout treatment and rose still further with resumption of ovarian activity. The length of the luteal phase and the mid-luteal serum progesterone concentrations were also normal. Pulsatile secretion of progesterone in response to LHRH pulses were observed. These data show that ovulation and normal luteal function can be induced by physiological LHRH replacement in women with persistent hyperprolactinaemia. This confirms that the mechanism of anovulation in hyperprolactinaemic amenorrhoea is disordered LHRH secretion.
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PMID:Ovulation and normal luteal function during LHRH treatment of women with hyperprolactinaemic amenorrhoea. 353 12

Although anovulation associated with hyperprolactinemia is not an uncommon cause of infertility, the precise mechanism of the pathogenic process that induces hyperactivity (hypertrophy with hyperplasia) of pituitary lactotropes is unknown. We have recently experienced a case of anovulation and hyperprolactinemia in a woman with ergot alkaloid intolerance in whom ovulation was restored by tamoxifen citrate administration. Since tamoxifen citrate administration also suppressed prolactin levels, it was suggested that a low but sustained serum level of estradiol and consequently continuous estrogenic stimulation may be an important causative factor in the development of hyperprolactinemic anovulation.
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PMID:Evidence that estrogen may be a key factor in hyperprolactinemic anovulation: a case report. 361 80

Infertility associated with anovulation and loss of regular oestrous cyclicity is a consequence of diabetes mellitus in the rat. In an attempt to define loci of altered function, studies were undertaken to examine various aspects of hypothalamic-pituitary function in rats treated with streptozotocin. Medial basal hypothalamic fragments from adult female diabetic rats contained the same amount of gonadotrophin-releasing hormone but, with depolarization, released slightly but insignificantly (p greater than 0.05) more than did those from control animals. Furthermore, release of luteinizing hormone from pituitaries exposed to hypothalamic gonadotrophin-releasing hormone was not altered by diabetes. Removal of the negative feedback effect of gonadal steroids upon the hypothalamic-pituitary axis produced an increase in luteinizing hormone and follicle stimulating hormone concentrations in the serum of normal rats within 6h (p less than 0.05), whereas 24h were required for similar increases in diabetic rats. However, the same concentrations of gonadotrophins were found in diabetic and control animals 120 h after ovariectomy. The inhibitory action of oestradiol benzoate on the secretion of gonadotrophins was more pronounced in ovariectomized diabetic than in control rats. A 74% depression in serum luteinizing hormone (p less than 0.01) was produced by 0.5 microgram oestradiol benzoate per day in diabetic rats, while 5 micrograms was required in control animals. Similar reductions in follicle stimulating hormone concentrations (50%, p less than 0.05) were obtained by injecting 5 micrograms of the oestrogen into diabetic or 50 micrograms into control rats. Increases in serum prolactin were greater in the control animals however.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Altered hypothalamic-pituitary function in the adult female rat with streptozotocin-induced diabetes. 392 97

Hyperprolactinemia is a major cause of anovulation and female infertility. However, we found 22 hyperprolactinemic patients with preserved ovarian function as assessed by midluteal plasma progesterone levels greater than 7 ng/ml. We performed a gel chromatography on the plasma of six of those patients to study the circulating pattern of prolactin (PRL). In all six patients we found that the vast majority of circulating PRL corresponds to big,big and big PRL, with only a small proportion of monomeric biologically active PRL. This finding might explain the preserved luteal function in those women and might have therapeutic implications.
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PMID:Chromatographic pattern of circulating prolactin in ovulatory hyperprolactinemia. 393 1

Progressively increasing plasma prolactin (PRL) concentrations are currently associated with menstrual disturbances, anovulation and cessation of cyclic activity. Galactorrhea-amenorrhea in the presence of normal plasma PRL is rare, but the favorable response to bromocriptine confirms its lactogen dependency. The concept of "transient hyperprolactinemia' is analyzed and alternative explanations for the positive results of dopamine agonist therapy in this particular condition are proposed. Moderate hyperprolactinemia can be associated with luteal inadequacy and infertility. Inhibition of PRL secretion with bromocriptine can normalize luteal function and restore the ability to conceive.
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PMID:Management of borderline hyperprolactinemia. 405 40

Competitive swimmers were followed over a 2-year period when they trained at different levels of exercise which coincided with distinct changes in their menstrual history. Oligomenorrhea was identified in 5 of 13 of these athletes when they swam approximately 100,000 yards per week. Weight and percentage of body fat were not significantly different between the period of oligomenorrhea and regular menstrual function (P = 0.24). Mean and median levels of luteinizing hormone, follicle-stimulating hormone, prolactin, and 17beta-estradiol were decreased and catechol estrogens and beta-endorphins were increased in serum during the strenuous, when compared with the moderate, training period. The serum levels of the steroid and protein hormones were similar to those of normal cycling, nonexercising control subjects during moderate exercise (60,000 yards per week). The significant differences between beta-endorphins and catechol estrogens during periods of strenuous exercise suggest an explanation for oligomenorrhea in female athletes. These hormonal changes result in hypothalamic anovulation, which appears to be reversible, because the hormone levels and menstrual cycles return to normal when the exercise is reduced.
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PMID:The role of beta-endorphins and catechol estrogens on the hypothalamic-pituitary axis in female athletes. 609 53

Twelve cases of galactorrhea in women with normal menstrual cycles who were radiologically free of any pituitary adenomas were investigated. Determinations were made for serum thyroid-stimulating hormone (TSH), T3 resin uptake (T3RU), total thyroxine by radioimmunoassay (T4), free thyroxine index (FT4I), norepinephrine, epinephrine, prolactin and urinary luteinizing hormone, total estrogens, pregnanediol and total catecholamines. Psychologic evaluation and assessment were also done using the Middlesex Hospital Questionnaire and the Eysenk, manual dexterity, Bender Gestalt and trial-making scales. Hypothyroidism associated with moderate hyperprolactinemia and anovulation were the main features in eight cases. Associated psychologic disturbances were reported. The other four cases showed significant elevations in serum epinephrine, norepinephrine and urinary total catecholamines with concomitant pathologic scales of anxiety and neuroticism. Thyroxine replacement and psychotherapy are recommended in the treatment of such cases.
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PMID:Endocrinologic and psychologic aspects of galactorrhea associated with normal menstrual cycles. 611 55

Estrogens are involved in the regulation of the secretion and release of prolactin, and so are a large number of neurotransmitters and neuropeptides. This explains why the circulating level of prolactin is very labile. Most of these elements work by bringing about small changes in the tone of the dopaminergic inhibitor system, which is the principal controlling factor for this hormone. Most hyperprolactinaemias of a pathological nature seem to be the result of a failure of this dopaminergic inhibiting system. Prolactin has a rudimentary luteotrophic function, but it does act as an inhibitor of female gonadic function as soon as the circulating level reaches about 30 ng/ml, and it exerts its effects at two levels--the ovarian and the hypothalamic. Estimating levels of prolactin should be carried out according to a strict protocol so that many causes of non-pathological rise can be excluded. Hyperprolactinaemia should be sought whenever anovulation is found whether it is accompanied by galactorrhoea or not. Certain cases of hyperprolactinaemia are secondary to different types of aetiology which have to be searched for. When confronted with a case of primary hyperprolactinaemia the search should be towards diagnosis of a pituitary adenoma, which is often present although very small. Two examinations that are of most value to diagnose this condition are standard X-rays of the pituitary fossa and scanning tomography.
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PMID:[Prolactin, bromocriptine and gonadic function in women: recent discoveries. I. The physiology of prolactin and the physiopathology and diagnosis of hyperprolactinaemias]. 612 96

We have evaluated daily blood levels of gonadal steroids and trophic hormones in the cycles of four ovulatory and six anovulatory patients with a luteinizing hormone (LH) surge. The cycles of anovulatory nonhirsute patients were characterized by a premature and blunted LH surge and by low levels of follicle-stimulating hormone (FSH) throughout the study period in the face of normal tonic and peak levels of estrone and estradiol (E2). These observations, together with decreased levels of prolactin, suggest a hypothalamic pituitary abnormality as the cause of anovulation in these patients. The cycles of anovulatory hirsute patients were marked by a decrease in E2 production and a blunted and delayed E2 peak. Androgen levels were elevated throughout the cycle and may have a direct inhibitory effect on ovarian folliculogenesis. The LH/FSH ratio in the follicular phase was high in both groups of anovulatory patients when compared with ovulatory controls; however, the shifts in gonadotropin levels producing the increase in this ratio were different for these two groups.
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PMID:Daily blood hormone levels related to the luteinizing hormone surge in anovulatory cycles. 640 Dec 51


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