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Oligomenorrhea amenorrhea [keywords]
- Correlation between hyperprolactinemia, MRI of hypophysis and clinical presentation in infertile patients. [Journal Article]
- Med Arh 2013; 67(1):22-4.
The aim of the study was to investigate symptoms of hyperprolactinemia such as oligomenorrhea, amenorrhea, galactorrhea, and correlation between hyperprolactinemia and MRI of hypophysis in infertile women.During the 10 years period, we have studied 87 patients investigated for infertility causes and with hyperprolactinemia findings, in our patients we have controled the serum prolactin levels, performed MRI of hypophysis, evaluated menstrual cycle disturbances and galactorrhea. Patients were between 20-43 of age.MRI of hypophysis confirmed prolactinoma (microadenoma) in 75.86% of our patients, while 24.14% had a normal MRI. Galactorrhea was demonstrated in 56.32% of patients. Oligomenorrhoea occured in 25.29%, and secondary amenorrhea in 14.94% of patients with hyperprolactinemia and infertility. The results show statistically significant difference in the average findings of serum prolactin levels on the day 8 and 21 of menstrual cycle in patients with or without microadenoma.Menstrual cycle disturbancies (oligomenorrhea and secondary amenorrhea) in patients with hyperprolactinemia and infertility occured in 40.33% of patients. We have noted statisctically significant correlation between the serum prolactin levels on the day 8 of menstrual cycle and the microadenoma size, which was not found on the 21 day of menstrual cycle.
- Ethnic differences in the phenotypic expression of polycystic ovary syndrome. [JOURNAL ARTICLE]
- Steroids 2013 Apr 25.
Polycystic ovary syndrome (PCOS) is the most common endocrine problem affecting women of reproductive age and is investigated from many regions of the world. Some reports have indicated ethnic difference in its manifestation. This review addressed the evidences for ethnic variation in the expression of PCOS phenotypes and explored the potential ethnic-specific diagnosis of this syndrome. To determine ethnic variation, community prevalence and clinical and metabolic problems, including hyperandrogenism, oligomenorrhoea/amenorrhoea, polycystic ovaries, obesity, insulin resistance and the metabolic syndrome, had been compared from differing backgrounds and populations. Moreover, a link between ethnicity and variation in the metabolic phenotype of PCOS had also been identified. East Asian women with PCOS have a lower BMI and a milder hyperandrogenic phenotype, but with the highest prevalence of metabolic syndrome. South Asians in particular have a high prevalence of insulin resistance and metabolic syndrome, and are at risk for type 2 diabetes, with central obesity more than BMI reflecting their metabolic risk. African American and Hispanic women are more obese and more prone to metabolic problems. Besides, there is a higher prevalence of hirsutism among women of Middle Eastern and Mediterranean origin. Ethnically appropriate guidelines are needed for identifying anthropometric thresholds for better screening and diagnosis in high-risk ethnic groups.
- [Clinical use for anti-mullerian hormone in gynecology]. [English Abstract, Journal Article]
- Rev Bras Ginecol Obstet 2013 Mar; 35(3):136-40.
Anti-mullerian hormone (AMH) is a glycoprotein produced by granulosa cells of primary, pre-antral and small antral ovarian follicles and its clinical applicability has been recently demonstrated by several studies. Prediction of the response to ovarian stimulation for in vitro fertilization corresponds to the most frequent utilization of AMH in clinical practice, being routinely assessed in many services to identify subgroups of women susceptible to a poor response or to Ovarian Hyperstimulation Syndrome. There are great perspectives that AMH may be applicable to the individual determination of risk for iatrogenic gonadal injury in women with neoplasms who will be submitted to chemotherapy. It is also probable that AMH assessment will be included in protocols for the investigation of amenorrhea and oligomenorrhea, since AMH levels are increased in Polycystic Ovary Syndrome, reduced in premature ovarian failure and normal in other conditions such as hyperprolactinemia and hypogonadotropic hypogonadism. It is possible that AMH will be utilized in the future for the prediction of age at menopause and of reproductive prognosis, providing solid bases for pre-conceptive and contraceptive counseling.
- Steroid cell tumor of the ovary in an adolescent: a rare case report. [Journal Article]
- Case Rep Med 2013.:527698.
Steroid cell tumors (SCTs) of the ovary are a rare subgroup of sex cord tumors, account for less than 0.1% of all ovarian tumors, and also will present at any age. These tumors can produce steroids, especially testosterone, and may give symptoms like hirsutism, hair loss, amenorrhea, or oligomenorrhea. For the evaluation of androgen excess, testosterone and dehydroepiandrosterone sulfate (DHEA-S) are the first laboratory tests to be measured. A pelvic ultrasound and a magnetic resonance imaging are useful radiologic imaging techniques. Although steroid cell tumors are generally benign, there is a risk of malignant transformation and clinical malignant formation. Surgery is the most important and hallmark treatment.
- Endometrioid endometrial carcinoma indirectly caused by pituitary prolactinoma: a case report. [Journal Article]
- Case Rep Oncol 2013 Jan; 6(1):25-30.
We present the case of a 44-year-old nulliparous woman who experienced irregular menstrual cycles for about 10 years and developed both pituitary prolactinoma and endometrioid endometrial carcinoma. In premenopausal women, hyperprolactinemia causes hypogonadism by inhibiting secretion of gonadotropin-releasing hormone and thus suppressing luteinizing hormone levels, which can cause menstrual disorders ranging from amenorrhea, oligomenorrhea and chronic anovulatory cycle to short luteal phase of the menstrual cycle. A chronic anovulatory menstrual cycle is the most common cause of long-term exposure of the endometrium to endogenous estrogen without adequate opposition from progestins, which can lead to endometrioid endometrial carcinoma. In this case, pituitary prolactinoma may have caused the chronic anovulatory cycle and indirectly led to the endometrioid endometrial carcinoma. In patients for whom the cause of irregular menstruation and chronic anovulatory cycle is suspected to be hyperprolactinemia, explorations of both the hypophysis and endometrium are essential.
- Virilizing sclerosing-stromal tumor of the ovary in a young woman with McCune Albright syndrome: clinical, pathological, and immunohistochemical studies. [Case Reports, Journal Article]
- J Clin Endocrinol Metab 2013 Feb; 98(2):E314-20.
McCune-Albright syndrome (MAS) is characterized by polyostotic fibrous dysplasia, café-au-lait skin pigmentations, and gonadotropin-independent sexual precocious puberty, resulting from a somatic postzygotic activating mutation of the GNAS1 gene.We report a virilizing sclerosing-stromal tumor of the ovary in a young female with MAS.She presented polyostotic fibrous dysplasia of the left upper and lower limbs and a café-au-lait skin spot in the posterior area of the neck. She had a history of precocious puberty, diagnosed at the age of 6 years and treated with cyproterone acetate until the age of 10 years; then she developed central puberty with severe oligomenorrhea. At the age of 23 years, she was hospitalized for a virilization syndrome including hirsutism, acne, deepening of the voice, amenorrhea, and clitoromegaly. Serum levels of T were dramatically increased (1293 ng/dl; normal range, 10-80). The abdominal computed tomography scan revealed a solid mass located on the left ovary.An ovariectomy was performed, and histological examination revealed a sclerosing-stromal tumor with pseudolobular pattern.Immunohistochemical studies revealed that the tumor cells expressed all steroidogenic enzymes involved in androgen synthesis. Molecular analysis revealed that ovarian tumor cells harbored the Arg 201 activating mutation in the GNAS1 gene. After surgery, T levels returned to normal, the patient retrieved a normal gonadal function, and she was able to become pregnant.This observation extends the clinical spectrum of ovarian pathology of women with MAS. However, the mechanisms causing this ovarian tumor remain unclear, even if the gsp oncogene has been implicated in the pathogenesis of some gonadal tumors.
- Mentha longifolia syrup in secondary amenorrhea: a double-blind, placebo-controlled, randomized trials. [Journal Article]
- Daru 2012; 20(1):97.
ABSTRACT:Amenorrhea is defined as the cessation of menses. Hormone therapy is the most common treatment. Due to the contraindications and side effects of it and the increasing demand for alternative medicine substitutes, Mentha longifolia L. was used in this study. Mentha longifolia L. is a known medication in Iranian traditional medicine to induce menstrual bleeding in women with secondary amenorrhea and oligomenorrhea.A double-blind, randomized, placebo-controlled, multicenter study was conducted in 120 women with secondary amenorrhea and oligomenorrhea. Treatment consisted of sequential oral syrup, 45 ml (15 ml three times a day) for 2 weeks. If the patients did not have menstruation after 2 weeks of taking the medication, we would wait for two more weeks. If the patients had menstruation at each stage of using the drug, we started it one week after the end of menstruation. But if the patients had not menstruate after four weeks (two-week using of drug and waiting for two more weeks), the previous steps were repeated. The drug and placebo were repeated in three cycles of menstruation. Bleeding was documented by the patient on diary cards. The primary outcome variable was the occurrence (yes/no) of bleeding during the first treatment cycle. The secondary efficacy outcome was the regularity of bleeding pattern during the three cycles of the study.The number of women with bleeding during the first cycle were higher in the drug group as in the placebo group (68.3% vs. 13.6%; p < 0.001). The regularity of bleeding throughout the study was markedly better in the drug group compared with those given placebo (33.3% vs. 3.3%; p < 0.001). No notable complication or side effect was reported in relation to Mentha longifolia L. syrup.In conclusion, Mentha longifolia L. syrup is a safe, well-tolerated, and effective choice in inducing bleeding and maintaining regular bleeding in women with secondary amenorrhea and oligomenorrhea.
- [State of nutrition and diet habits versus estradiol level and its changes in the pre-season preparatory period for the league contest match in female handball and basketball players]. [English Abstract, Journal Article]
- Ginekol Pol 2012 Sep; 83(9):674-80.
Intense exercise is known to induce menstrual disturbances--irregular menstrual cycles, oligomenorrhea and amenorrhea in female athletes. Menstrual disturbances, followed by hypoestrogenism, are associated with infertility decreased bone mineral density high prevalence of stress fractures, and endothelial dysfunction.The aim of the study was to assess the effect of nutrition and diet habits on the estradiol level and its changes in the pre-season preparatory period for the league contest match in female handball and basketball players.Fifty healthy young female handball and basketball players were enrolled into the study before the opening of the season, after a 2-month holiday period, without regular physical activity and diet restrictions. Serum estradiol was determined at the beginning and after 3 months of moderate aerobic training. Each woman was studied between the 3rd and 5th day of her menstrual cycle. In all subjects, medical history was obtained, together with the anthropometric measurements (body mass and height). The body mass index was calculated according to the standard formula. The use of hormonal contraception in the last 3 months, low-caloric diet in the last 6 months, body mass changes of more than 3 kilograms in the last 6 months, secondary amenorrhea and stress fractures in medical history constituted the exclusion criteria. Informed consent was obtained from each participant and the study protocol was approved by the Ethics Committee of the Medical University of Silesia. Venous blood samples (2 ml) for estradiol levels measurements were taken twice: at the beginning of the preparatory period and after three months of moderate aerobic exercise training (20 hours per week). Blood samples were collected according to the kit manufacturer's recommendations. Serum and plasma samples were stored frozen at -80 degrees C. Serum estradiol was determined by enzyme-linked immunosorbent assay (ELISA) (DRG Instruments GmbH, Marburg, Germany) with a lower limit of sensitivity of 9.714 pg/mL; the intra- and inter-assay coefficients of variation were 4.7% and 7.8%. All statistical analyses were performed with the use of Statistica 8.0 software. The results are presented as means +/- SD. The Wilcoxon rank test was used to compare the before and after exercise measurements. The Mann-Whitney U test was used for subgroups comparisons. The results were considered statistically significant when the p value was less than 0.05.After a 2-month holiday period, without regular physical exercise, p < 0.01) serum estradiol level was significantly lower in the basketball than handball players (48.7 +/- 19.6 vs. 62.3 +/- 18.9 pg/ml, p < 0.01). Although, no body mass changes were noticed (delta = - 0.3 +/- 0.3 kg), after 3 months of moderate aerobic training estradiol level was significantly decreased in the whole study population (58.0 +/- 20.0 vs. 41.4 +/- 18.9 pg/ml, p < 0.001).Diet habits and nutrition did not correlate with estradiol plasma levels in female handball and basketball players after a 2-month holiday period. Regular exercises correlate with the decrease of serum estradiol level even without body mass changes.
- The quality of life of adolescents with menstrual problems. [Journal Article, Research Support, Non-U.S. Gov't]
- J Pediatr Adolesc Gynecol 2013 Apr; 26(2):102-8.
To date, very few publications have examined the health related quality of life (HRQL) in the younger population with menstrual problems, despite their high prevalence in adolescent girls. We describe the health-related quality of life (HRQL) among adolescents with menstrual problems and identified factors that have an impact on it.The study was a questionnaire study (using PedsQL 4.0) of adolescents aged 13-18 referred to a tertiary gynecology center for menstrual problems between June 2009 and August 2010.One hundred eighty-four adolescents completed the questionnaires. The mean age was 15.10 ± 1.49 with the mean body mass index (BMI) of 22.83 ± 4.82 kg/m(2). The most common menstrual problems seen in the clinic were dysmenorrhea (38.6%) followed by heavy bleeding (33.6%), oligomenorrhea (19.6%), and amenorrhea (8.2%). The mean overall score was 70.40 ± 16.36 with 42.3% having a score below 1 standard deviation (SD) from the norms. Adolescents with dysmenorrhea had the poorest score in physical function, whereas those with amenorrhea had the lowest score in psychosocial function. Maternal parenting style, parental anxiety, adolescents' ill-health behavior, and BMI have been found to have impact on the girls' quality of life (QoL).Although menstrual problems are not life threatening, they can pose a significant impact on the quality of life of these patients. Identification of these impacts might lead to the recognition of potential services or education to improve this. Understanding the characteristics that predict QoL may help a clinician identify patients who are risk for poor QoL.
- Evaluation of common mental disorders in women with polycystic ovary syndrome and its relationship with body mass index. [Journal Article]
- Rev Bras Ginecol Obstet 2012 Oct; 34(10):442-6.
To evaluate the prevalence of common mental disorders in women diagnosed with polycystic ovary syndrome as compared with paired controls without this syndrome.Cross-sectional study with a Control Group examining women between the ages of 18 and 30 who did not use antidepressants and who sought the Gynecology Service of the researched sites. For every woman diagnosed with the polycystic ovary syndrome, another with the same age, educational status and presence or absence of sexual partners was sought without this diagnosis. In total, 166 patients agreed to participate, consisting of 95 diagnosed with polycystic ovary syndrome and 71 in the Control Group. The diagnosis of polycystic ovary syndrome was made by the presence of two from three criteria: oligomenorrhea or amenorrhea, clinical or biochemical hyperandrogenism and polycystic ovaries on transvaginal ultrasound, following exclusion of patients with Cushing's syndrome, congenital adrenal hyperplasia, and androgen-secreting tumors. Weight and height were measured to calculate the body mass index. The Self-Reporting Questionnaire, which evaluated 20 items, was used as an indicator of common mental disorders. A χ² analysis stratified by the category of body mass index was used to compare the prevalence of common mental disorders, between the groups of women with and without the polycystic ovary syndrome.There were no significant differences in age, education, presence of sexual partners, ethnicity, socioeconomic status, use of psychiatric medication, and search for consultation in mental health between the studied groups. The prevalence of obese women with indications of common mental disorders was significantly higher in women with polycystic ovary syndrome than in the Control Group. In the group with healthy body mass index, the incidence of common mental disorders was statistically significant different between women with polycystic ovary syndrome and normal controls (p=0.008).Women with diagnosis of this disease have an almost three-fold increased likelihood of common mental disorders as compared with those without polycystic ovary syndrome. Although obesity is often observed in polycystic ovary syndrome, even women with a healthy body mass index have an increased risk of psychiatric comorbidity.