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

The spontaneous pattern of pituitary gonadotropins and ovarian steroids and their response to dynamic tests were measured in 12 women with polycystic ovarian syndrome (PCO) and the results compared to those from 6 normal women during the early follicllar phase of the cycle (controls). As judged by serial measurements of urinary total estrogen and pregnanediol over a 12-week period, in PCO patients 75% of cycles were anovulatory (anovulatory PCO) as compared to 100% ovulatory in controls. The basal concentrations of LH, androstenedione and estrone were significantly higher and the concentration os FSH significantly lower in anovulatory PCO than in the controls (P less than .05). In PCO patients the concentration of LH was lower following an ovulatory cycle than that following a period of anovulation. Negative and positive feedback responses to an estrogen provocation test (200 microgram ethinyl estradiol per day for 3 days) were normal in anovulatory PCO although the LH peak occurred 24 h earlier than in the controls. The amplitude of the pulses of LH was significantly greater in anovulatory PCO than in the controls and was suppressed in both groups after ethinyl estradiol. The peak release of LH in response to 56 microgram LRF in ovulatory PCO was similar in controls but LH responses in anovulatory PCO were significantly greater. It is suggested that the abnormalities in gonadotropin secretion in PCO are secondary to excessive and prolonged extraglandular production of estrogen from androstenedione.
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PMID:Pituitary-ovarian relationships in polycystic ovary syndrome. 33 89

Infertility has a 30-40% incidence in women with endometriosis. However, conservative surgical procedures can result in pregnancy for 40-90% of these patients. The pregnancy rate is influenced by 5 factors: 1) extent of the disease, 2) age, 3) history of previous surgery for endometriosis, 4) duration of infertility before surgery, and 5) length of postsurgical follow-up. The factor responsible for infertility among women with endometriosis is believed to be an inadequacy of the tubo-ovarian motility secondary to fibrosis and scarring, which results in imperfect ovum acceptance by the fimbriae. Therapy encompasses 4 approaches: 1) prophylaxis, 2) observation and analgesia, 3) suppression of ovulation, and 4) surgical treatment. Pregnancy is suggested as the optimal prophylactic treatment for endometriosis since the symptoms and signs regress during gestation and for varying periods thereafter. This regression is probably due to a combination of anovulation and amenorrhea caused by adenohypophyseal suppression. It may also be due to a transformation of functioning endometriotic tissue into decidua by increasing levels of chorionic estrogen and progesterone. If pregnancy is not desired, anovulation can be secured by the administration of sex hormones. Pseudopregnancy for 6 months, induced by norgestrel plus ethinyl estradiol or norethynodrel plus mestranol, can lead to pregnancy in 50% of patients whose only abnormality is surface ovarian endometriosis within 1 year of cessation of therapy. Short periods of pseudopregnancy are also advocated after conservative surgery if all areas of endometriosis cannot be excised. 40-50% of these patients can expect to become pregnant within 24 months. The incidence of postoperative tubo-ovarian adhesions may be diminished by use of dexamethasone and promethazine.
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PMID:Management of endometriosis in the infertile patient. 80 66

Oral contraceptives have been implicated as a causative factor of venous thrombosis and thromboembolism. Compounds containing over 50 mcg of estrogen have developed this complication most frequently. Steroid hormones have a marked influence on liver function. Large doses have caused cholestasis and hepatocellular damage. Disturbances in carbohydrate metabolism have been recorded. Lipid metabolism have also been shown to be disturbed with increased serum levels of triglycerides and low density lipoproteins. A rise in the cholesterol serum level seems to be correlated with the progestogen content of the compound. The ''minipill'' with a small dose of progestogen alone had been effective by alteration of the cervical mucus. The ''one-a-month pill'' is a combination of a long-acting estrogen, quinestrol, and a chorter acting progestogen, qunigestanol acetate. It has not been as acceptable or as effective as combined compounds. The ''morning-after'' pill consists of large doses of stilbestrol. The method has been effective but when de-ethylstilbestrol has been given to a patient already pregnant to prevent an early spontaneous abortion, adenocarcinoma of the cervix or vagina has been reported. Hypertension has been more common with increased duration of pill use. High dosage of progestogens and increasing age of patients have increased the incidence of hypertension. Cerebrovascular disease had also been more frequent among pill users. An increased incidence of gallbladder disease and of gallstones has been shown in pill users. Urinary tract and vaginal infections were reported more often in pill users. Increased sexual activity may have been a factor in this relationship. Resumption of ovualation after discontinuation of oral contraceptives usually follows within 4-6 weeks. In about 1% of patients amenorrhea and anovulation result for 6 months or more. This is often accopanied by galactorrhea. There is evidence that mestranol is demethylated to ethinyl estradiol in the liver. Progesterone seems to interfere with conversion. Therefore ethinyl estradiol is preferred as a compound of the pill. Also the different progestogens used are metabolized in the liver to norethisterone before they exert their biological effects. Several drugs, as ampicillin and barbiturates, have been shown to interfere with the efficacy of oral contraceptives. It is concluded that the overall results have shown oral contraceptives to be an excellent form of contraception with minimal and acceptable side effects and the least metabolic disturbance.
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PMID:Current status of oral contraceptive. 82 61

Physicians monitored serum concentrations of the synthetic progestin ST 1435, progesterone, and ethinyl estradiol in 9 healthy 28-42 year old women attending the outpatient clinic at City Maternity Hospital in Helsinki, Finland who agreed to apply ST 1435 gel to the periumbilical area daily for 21 menstrual cycles. They 1st applied it on day 5 of the menstrual cycle and continued treatment for 17-93 days. The physicians wanted to examine the daily dose of ST 1435 needed to suppress ovarian function and ovulation. A daily dose of 0.8 mg ST 1435 achieved the optimal serum concentration of ST 1435 (112-278 pmol/L) to inhibit ovulation. Each woman tended to have constant serum concentrations and those concentrations depended on the dose. All 3 different doses (0.5, 0.8, and 1 mg) affected ovarian function. The 0.5 mg/day dose prevented ovulation in 3 of 5 treatment periods while the 0.8 mg/day dose did in 7 of 10 cycles. Anovulation occurred in the only women who used the 1 mg/day dose. ST 1435 levels (mean 691 pmol/L) were high at this dose. Serum ethinyl estradiol levels differed among the women in each dose group and between dose groups. A few women even had very high levels which typifies progestin treatment. Irregular bleeding occurred in some women especially during the anovulatory cycles. Bleeding control was the only side effect. 0.8 mg/day of ST 1435 applied transdermally appeared to be an effective and acceptable contraceptive. Researchers should conduct more studies on transdermal ST 1435 to account for the interindividual differences in ST 1435 serum levels and to determine ST 1435's efficacy.
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PMID:Suppression of ovarian function with the transdermally given synthetic progestin ST 1435. 142 9

The hormonal effects of a combined, monophasic oral contraceptive (OC) containing 0.03 mg of ethinyl estradiol and 0.150 mg of desogestrel were compared in 9 adolescents with oligomenorrhea and ovarian hyperandrogenism and 8 controls with regular menstrual periods. All adolescents were treated for 6 consecutive months. Before treatment, the females with irregular periods had significantly higher basal luteinizing hormone (LH), delta 4-androstenedione (A), testosterone (T), and dehydroepiandrosterone sulfate (DHEA-S) levels than controls. In addition, the oligomenorrheic females had significantly lower sex hormone binding globulin (SHBG) levels and greater mean ovarian volume. OC treatment produced a decrease in all hormones (LH, follicle-stimulating hormone, delta-4 A, T, and DHEA-S) in girls in both groups and a significant increase in SHBG levels. Oligomenorrheic subjects further manifested a significant decrease in total ovarian volume, with reduced number or disappearance of all echo-free cystic follicles in both ovaries. With the exception of SHBG and ovarian volume in hyperandrogenic subjects, all parameters returned to pretreatment values 3 months after discontinuation of the OC. 6 of the 9 oligomenorrheic subjects showed subjective improvement of skin problems; in addition, 6 reported a longterm decrease in hair growth. Post-treatment, oligomenorrhea and anovulation persisted in 7 of the 9 subjects. Although the effect of this treatment is temporary, the ethinyl estradiol-desogestrel OC appears to be effective in hyperandrogenic adolescents and may delay the progression of hirsutism and prevent adult micropolycystic ovarian disease.
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PMID:Effect of a combination of ethinylestradiol and desogestrel in adolescents with oligomenorrhea and ovarian hyperandrogenism. 295 38

The antifertility effect of norgestimate (Ng), 0.250 mg, in combination with ethinyl estradiol (EE), 0.035 mg, on cervical mucus was investigated. The study was conducted over two consecutive cycles: a control cycle followed by a study cycle during which medication was given. Basal body temperature, cervical mucus and karyopyknotic index of vaginal cells were evaluated during both cycles. Disappearance of cyclicity of these parameters in the study cycle as well as monophasic basal body temperature were suggestive of inhibition of ovulation caused by the combination pill. Deterioration of sperm penetration may be reflective of anovulation and a direct antifertility effect of Ng on cervical mucus.
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PMID:Effects of norgestimate (0.250 mg) in combination with ethinyl estradiol (0.035 mg) on cervical mucus. 377 38

"Dysfunctional uterine bleeding" is not a generic term for abnormal uterine bleeding. Rather, it refers solely to bleeding caused by an ovarian endocrinopathy. Estrogen withdrawal and inappropriately sustained estrogen production are the two mechanisms responsible. The latter mechanism produces estrogen breakthrough bleeding, which is common in women with chronic anovulation. Treatment of estrogen withdrawal bleeding depends on when in the menstrual cycle bleeding occurs. Anovulatory bleeding is best treated with progestin. Estrogen therapy is contraindicated, except in patients with profuse anovulatory bleeding unresponsive to progestin treatment, because it increases the risk of endometrial hyperplasia and cancer.
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PMID:Dysfunctional uterine bleeding. Clarifying its definition, mechanisms, and management. 394 5

Serial assays of urinary estrogens, pregnanediol, follicle-stimulating hormone (FSH), and luteinizing hormone (LH), WERE PERFORMED IN 2 NORMAL women who developed amenorrhea as a result of oral contraceptive use. Case 1, a woman aged 28 with 2 children took Ovulen (mestranol .1 mg and ethynodiol diacetate 1.0 mg) for 25 months followed by a substitution of chlormadinone acetate (.5 mg per day) when she developed increased menstrual irregularity. Following withdrawal of the medication, vaginal bleeding began and lasted 4 days, and she experienced regular cycles for the subsequent 2 years. The second woman aged 21 developed amenorrhea after 17 months' use of Gynovlar (ethinyl estradiol .05 mg and norethistrone acetate 3.0 mg). Amenorrheic for 21 months at the time of investigation, she was given clomiphene citrate for 5 days (50 mg/day). Further treatment with clomiphene and Pergonal (Serono-Rome) was necessary to resume normal cycles and permit conception which led to full term delivery. Estrogen levels were similar to those of the follicular phase of the normal menstrual cycle; however, they rose spontaneously to midcycle levels in case 1 and as a result of clomiphene treatment in case 2. FSH levels were normal but failed to show consistent patterns; LH patterns were highly irregular in both cases. The findings are consistent with the hypothesis that longterm therapy by oral contraceptives may cause irregular cyclic release of gonadotrophins at the hypothalamic level resulting in amenorrhea and anovulation.
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PMID:Endocrinological studies in two patients with post contraceptive cyclic dysfunction. 464 85

This paper reports a clinical evaluation of the mechanism of action of clomiphene citrate and describes selection of the most responsive patients. Patients were 121 women, aged 21-37 years, who desired pregnancy. Their infertility was diagnosed as being due to anovulation. Primary amenorrhea or special endocrine disorders were not present. All the women who had no vaginal bleeding for more than 2 months were diagnosed amenorrhea and treated with 65 mg of progesterone capronate intramuscularly. They were then divided into two subgroups on the basis of the presence or absence of vaginal bleeding within 2 weeks. Clinical studies included: basal body temperature charts; daily vaginal smears evaluated by the ink acidophilic stain index (ISI); cervical mucus evaluated by amount, spresence of spinnbarkeit, and ferning; 24-hour urines examined for estrogen and total gonadotropic activity; and a pregnanediol determination. Each group received daily 50 mg doses of clomiphene citrate for 5 days. Estrogen inhibiting effect of the drug was suggested by vaginal cytology and the disappearance of ferning and decrease in quantity of cervical mucus. However, the excretion of the total urinary estrogen was increased in ovulatory cases (81 of the 121 patients). In 17 patients having no bleeding within 2 weeks after progesterone injection no ovulation could be induced. In patients with withdrawal flow 54 of 70 achieved ovulation. Of 37 patients with previous anovulatory bleeding 27 achieved ovulation. There were 11 of the 121 who became pregnant. In those with early ovulation the antiestrogen effect is believed to be in the hypothalamus and pituitary bringing about the estrogen surge and stimulating LH secretion. In those with later ovulation the antiestrogenic effect increased FSH secretion followed by ovulation. The type of patient most likely to respond to clomiphene citrate is one with nearly normal pituitary-gonadal axis. Inducing withdrawal bleeding with progesterone in those amenarrheic patients who are to be treated with clomiphene citrate is believed to be a good method of anticipating the result of the treatment.
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PMID:Clomiphene citrate and its effects upon ovulation and estrogen. 502 17

The introduction of powerful ovulation induction agents, such as gonadotropins, has made an important contribution to the temporary elimination of the anovulation syndrome. Since the treatment is expensive and not without significant medical complication, it is vitally important to conduct therapy according to a well-defined monitoring system. In the past, clinicians have tended to monitor gonadotropin therapy by biophysical signs, but they were found to be insufficient monitors if used alone. Estrogen secretion from the ovaries does reflect the follicular maturation process. In this study a combined individualized method for hMG/hCG therapy is presented. Fifty-one infertile anovulatory women were treated for a total of 124 treatment cycles. All courses of therapy were judged to have induced ovulation. There was a good clinical correlation between cervical score and increasing estrogen levels. The pregnancy rate was 62.7%, with 60% of patients becoming pregnant within the first three cycles of treatment. In spite of the complications of less than 1% of severe hyperstimulation, 15.5% multiple gestation, and 28% of abortion rate, gonadotropin therapy is a most efficient tool in the treatment of infertility due to anovulation.
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PMID:Experience with combined individualized method of hMG/hCG therapy. 613 81


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