The use of gonadotrophin-releasing hormone (GnRH) agonist in anaemic subjects awaiting surgery - abstract

Gonadotrophin releasing hormone agonist (Goserelin) was used to induce amenorrhea in 27 women who were anaemic as a result of menorrhage due to uterine myomas (fibroids). The aim was to produce a three-month period of amenorrhoea which would be enough time for them to recover from the anaemic status and thus be fit for surgery. GnRH agonists supresses gonadotrophin release from the pituitary, thus inhibiting ovarian steroid secretion, resulting in amenorrhoea. Between March 1993 and May 1996, 27 women were injected with goserelin acetate (zoladex), 3.6 mg in the subcutaneous tissue of the anterior abdominal wall on a monthly basis for 3 months. Twenty three went on to have myomectomy. Haemoglobin (Hb) concentration and packed cell volume (PCV) were determined before initiation of treatment. Haemoglobin levels ranged from 4.7 g/dlto 9.9 g/dl and PCV ranged from 0.14 to 0.30 l/l. Three women did not have amenorrhea after the first injection and reported heavier periods, while three had prolonged light bleeding. All six, plus the other seventeen, had amenorrhoea after the second injection. All experienced hot flushed during the course of treatment and 5 (21.7 percent) had vaginal dryness by the third injection. Demineralization of done which is associated with these agents was not assessed. (Au)

Contraceptive use during lactational amenorrhea

OBJECTIVE: The study uses data from nationally representative sample surveys in developing countries to estimate the overlap between lactational amenorrhea and contraceptive use during the first 6 months postpartum. METHOD: Secondary analyses of survey data were used to tabulate the proportion of the population in lactational amenorrhea among contraceptive users of all women, for postpartum women and for the country as a whole. RESULTS: Among postpartum women, the proportion in lactational amenorrhea was particularly high in Africa and the Near East and lower in Latin America and the Caribbean where breast-feeding practices have declined. The median duration of use for oral contraceptives is also presented as an aid to interpreting the significance of the findings. CONCLUSIONS: The significance of the findings is considered in the context of planning reproductive health services in the postpartum period. Decisions about timing of contraceptive use for postpartum women, while arrived at on an individual basis, also result from program strategies that focus counseling immediately postpartum or at a later interval, such as when menses resume. On a national level the impact of postpartum contraception policies on use of commodities may be substantial.(AU)

Cytogenetic and clinical observations on West Indian patients with primary amenorrhea

Forty-seven patients with primary amenorrhea, oligomenorrhea, and secondary amenorrhea were investigated by chromosome examination, and laparotomy was performed in six. Thirty-six percent of patients with primary amenorrhea showed sex chromosomal abnormality, and two cases showed autosomal anomalities. We feel that undetected mosaicism was present in some of the sexual infantile patients with apparently normal complement; probably, several of this group have gonadal dysgenesis. No abnormality was detected in patients with virilization. However, we now believe that any patient without adrenal hyperplasia should have laparotomy and removal of abnormal gonadal tissue. Laparotomy and gonadal extirpation may be considered for patients with streak gonads without virilization. Patients with normal secondary sexual development deserve full and early investigation of the genital tract, as they may have congenital anomalities associated with normal ovaries (Summary)

Chromosome studies in primary amenorrhoea - abstract

Between April, 1964 and December, 1968, we have performed buccal smears and chromosome studies on a total of 46 patients with primary and secondary amenorrhoea and oligomenorrhoea. RESULTS: (1) Secondary amenorrhoea - 4 cases. All had normal chromosomes, all were over 62" in height, with normal build and sexual development. (2) Oligomenorrhoea - 10 cases. Five had moderate degrees of virilisation. One of these had chromosomal findings suggestive of XX/XO mosaicism. Five patients had normal secondary sex characteristics and had normal chromosomes. All 10 patients were 60" or more in height. (3) Primary Amenorrhoea 32 patients. These can be divided into 3 clinical groups. (a) Those with sexual infantilism - 21 cases. Of these, 10 showed sex chromosomal abnormalities. Six of these were less than 60" and hibited other features suggestive of gonadal dysgenesis. Of the 11 with normal chromosomes, 4 were under 57" in height and 3 of these were mentally retarded. (a) Those with sexual infantilism - 21 cases. Of these, 10 showed sex chromosomal abnormalities. Six of these were less than 60" and exhibited other features suggestive of gonadal dysgensis. Of the 11 with normal chromosomes, 4 were under 57" in height and 3 of these were mentally retarded. (b) Patients with virilisation - 7 cases. All these patients were small in size, around 60 to 63 inches in height, but were not dwarfed. Two were found to have congenital adrenal hyperplasia. The others have not all been fully investigated for this condition. (c) Normal secondary sex characteristics - 4 cases. Three had normal chromosomes. One patient had 46xx but a small line showed a small chromosomal fragment. Laparotomy revealed normal ovaries. Two other patients in this group had atresia of the vagina and cervix. CONCLUSION: 34 percent of patients with primary amenorrhoea have chromosmal abnormalities. Chromosome studies are, therefore, indicated in all such patients and probably some with oligomenorrhoea. All patients except those found to have congenital adrenal hyperplasia should have either full genital tract examinations or gonadal exploration, the former being indicated if there are normal secondary sex characteristics, and the latter if there is infantilism or virilisation not explained by congenital adrenal hyperplasia (AU)