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1.
Medicine (Baltimore) ; 98(35): e16996, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464951

RESUMO

RATIONALE: Hormone imbalance and menstrual irregularities are normal for postpill women. Pharmacopuncture and moxibustion can stimulate acupoints with herbal extract and heat, respectively, to regulate the function of qi and blood, expel pathogens, and support health. PATIENT CONCERNS: A 39-year-old female patient presented with amenorrhea, >6 months after she had stopped taking the oral contraceptive pill, which she had taken for more than 10 years, and possible associated infertility. Additionally, she reported sudden weight gain of approximately 12 kg in 1 year. DIAGNOSES: In this study, we examined the amenorrhea lasted more than 6 months for postpill patient. INTERVENTIONS: She refused a strong acupuncture stimulus; she underwent lower abdomen pharmacopuncture with wild ginseng complex (WGC) and moxibustion at CV4, 5 times during 1 month. As a secondary treatment, 1 g Geoseub-hwan pills were prescribed for overeating and during social events. After 5 weekly primary treatments, Geoseub-hwan was prescribed intermittently. OUTCOME: After 3 primary treatments, she began menstruation without menstrual cramps or discomfort. After 5 treatments, she exhibited improvement of body weight and body composition. At 1- and 3-month follow-up examinations, she confirmed regular menstruation without discomfort. LESSONS: Pharmacopuncture with WGC and moxibustion may be effective for the treatment of postpill amenorrhea with abdominal obesity and can be used for patients with fear of a strong acupuncture stimulus.


Assuntos
Terapia por Acupuntura/métodos , Amenorreia/terapia , Medicina Tradicional Coreana/métodos , Adulto , Amenorreia/etiologia , Terapia Combinada , Anticoncepcionais Orais/efeitos adversos , Feminino , Humanos , Moxibustão/métodos , Panax , República da Coreia , Ganho de Peso
2.
Am Fam Physician ; 100(1): 39-48, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31259490

RESUMO

Menstrual patterns can be an indicator of overall health and self-perception of well-being. Primary amenorrhea, defined as the lifelong absence of menses, requires evaluation if menarche has not occurred by 15 years of age or three years post-thelarche. Secondary amenorrhea is characterized by cessation of previously regular menses for three months or previously irregular menses for six months and warrants evaluation. Clinicians may consider etiologies of amenorrhea categorically as outflow tract abnormalities, primary ovarian insufficiency, hypothalamic or pituitary disorders, other endocrine gland disorders, sequelae of chronic disease, physiologic, or induced. The history should include menstrual onset and patterns, eating and exercise habits, presence of psychosocial stressors, body weight changes, medication use, galactorrhea, and chronic illness. Additional questions may target neurologic, vasomotor, hyperandrogenic, or thyroid-related symptoms. The physical examination should identify anthropometric and pubertal development trends. All patients should be offered a pregnancy test and assessment of serum follicle-stimulating hormone, luteinizing hormone, prolactin, and thyroid-stimulating hormone levels. Additional testing, including karyotyping, serum androgen evaluation, and pelvic or brain imaging, should be individualized. Patients with primary ovarian insufficiency can maintain unpredictable ovary function and may require hormone replacement therapy, contraception, or infertility services. Functional hypothalamic amenorrhea may indicate disordered eating and low bone density. Treatment should address the underlying cause. Patients with polycystic ovary syndrome should undergo screening and intervention to attenuate metabolic disease and endometrial cancer risk. Amenorrhea can be associated with clinically challenging pathology and may require lifelong treatment. Patients will benefit from ample time with the clinician, sensitivity, and emotional support.


Assuntos
Amenorreia/diagnóstico , Amenorreia/etiologia , Amenorreia/terapia , Diagnóstico Diferencial , Feminino , Humanos , Anamnese , Exame Físico , Guias de Prática Clínica como Assunto
3.
Am J Physiol Heart Circ Physiol ; 317(3): H487-H495, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31322425

RESUMO

Female athletes display a high prevalence of hypothalamic amenorrhea as a result of energy imbalance. In these athletes with amenorrhea, decreased luteinizing hormone/follicule-stimulating hormone secretion leads to deficiency in endogenous estrogen. The severe estrogen deficiency in these athletes may increase cardiovascular risk similar to that in postmenopausal women. This review discusses the potential cardiovascular risk factors in athletes with amenorrhea as a result of hypoestrogenism, which include endothelial dysfunction and unfavorable lipid profiles. We also consider the potential to reverse the cardiovascular risk by restoring energy or hormonal imbalance along the reproductive axis in athletes with amenorrhea.


Assuntos
Amenorreia/terapia , Atletas , Doenças Cardiovasculares/prevenção & controle , Metabolismo Energético/efeitos dos fármacos , Terapia de Reposição de Estrogênios , Estrogênios/deficiência , Amenorreia/epidemiologia , Amenorreia/metabolismo , Amenorreia/fisiopatologia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/metabolismo , Doenças Cardiovasculares/fisiopatologia , Feminino , Hormônio Foliculoestimulante Humano/metabolismo , Humanos , Mediadores da Inflamação/metabolismo , Hormônio Luteinizante/metabolismo , Medição de Risco , Fatores de Risco
4.
Lancet Child Adolesc Health ; 2(9): 677-688, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30119761

RESUMO

Female athletes often experience amenorrhoea at various times during training, but this should not be considered normal. Low energy availability is a common cause of menstrual dysfunction, and amenorrhoea can serve as a warning sign of some of the health and performance consequences associated with inadequate energy, including poor bone accrual and low bone mineral density. Adolescence is an important time for bone accrual, growth, and development, making delayed menarche and secondary amenorrhoea particularly concerning in young athletes. The development of disordered eating and eating disorder behaviours also peaks during adolescence. Thus, screening for low energy availability, establishing the various causes of amenorrhoea, and treating amenorrhoea and low energy availability with an interdisciplinary team is most effective.


Assuntos
Amenorreia , Esportes , Adolescente , Algoritmos , Amenorreia/diagnóstico , Amenorreia/etiologia , Amenorreia/metabolismo , Amenorreia/terapia , Feminino , Hormônios/fisiologia , Humanos , Esportes/fisiologia
5.
Taiwan J Obstet Gynecol ; 56(6): 761-764, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29241916

RESUMO

OBJECTIVE: To determine the prevalence of etiologic causes of primary amenorrhea in Indian population. MATERIALS AND METHODS: A retrospective study was performed using 102 complete medical records of women with primary amenorrhea who attended the Gynaecologic Endocrinology Clinic, Department of Obstetrics and Gynaecology, AIIMS, New Delhi from September 2012 to September 2015. Cases were analysed according to clinical profile, development of secondary sexual characteristics, physical examination, pelvic and rectal examination, X-ray of chest and lumbo-sacral spine, hormone profile, pelvic USG, MRI, and cytogenetic study including karyotype. RESULTS: The three most common causes of primary amenorrhea were Mullerian anomalies (47%), gonadal dysgenesis (20.5%), and hypogonadotropic hypogonadism (14.7%) in the present study. There were 3 cases of Turner syndrome (45,XO), 5 cases of Swyer's syndrome (46,XY) and 2 cases of Androgen insensitivity syndrome (46,XY). One case had pituitary macroadenoma and eight cases (7.8%) were of genital tuberculosis. CONCLUSIONS: The present study has currently been the largest case series of primary amenorrhea from North India. Mullerian anomaly is the most prevalent etiological factor leading to amenorrhoea followed by gonadal dysgenesis in our study. Racial, genetic and environmental factors could play role in the cause of primary amenorrhea.


Assuntos
Amenorreia/etiologia , Disgenesia Gonadal/epidemiologia , Hipogonadismo/epidemiologia , Ductos Paramesonéfricos/anormalidades , Adolescente , Adulto , Amenorreia/congênito , Amenorreia/terapia , Síndrome de Resistência a Andrógenos/complicações , Síndrome de Resistência a Andrógenos/epidemiologia , Gerenciamento Clínico , Feminino , Disgenesia Gonadal/complicações , Disgenesia Gonadal 46 XY/complicações , Disgenesia Gonadal 46 XY/epidemiologia , Humanos , Hipogonadismo/complicações , Índia/epidemiologia , Masculino , Prevalência , Estudos Retrospectivos , Centros de Atenção Terciária , Síndrome de Turner/complicações , Síndrome de Turner/epidemiologia , Adulto Jovem
8.
Prog. obstet. ginecol. (Ed. impr.) ; 60(2): 136-139, mar.-abr. 2017. ilus
Artigo em Espanhol | IBECS | ID: ibc-164054

RESUMO

Los tumores cardíacos primarios son entidades de rara aparición. Un 50% son mixomas y aparecen en adultos (edad media 56 años) y principalmente en mujeres. Presentamos un caso de un mixoma auricular diagnosticado en una paciente de 25 años de edad durante el segundo trimestre de la gestación. El tratamiento de elección es la exéresis quirúrgica, que en este caso fue realizada tras finalización de la gestación en la semana 35 de amenorrea (AU)


Primary cardiac tumors are rare appearance entities. 50% are myxomas and appear in adults (mean age 56 years) and especially in women. We report a case of atrial myxoma diagnosed in a 25 years old during the second trimester of pregnancy. The treatment of choice is surgical excision, which in this case was made after completion of pregnancy in week 35 of amenorrhea (AU)


Assuntos
Humanos , Feminino , Gravidez , Adulto , Complicações na Gravidez/fisiopatologia , Mixoma/cirurgia , Mixoma , Arritmia Sinusal/complicações , Arritmia Sinusal , Cirurgia Torácica/métodos , Segundo Trimestre da Gravidez , Amenorreia/terapia , Ecocardiografia , Osteogênese Imperfeita/genética , Eletrocardiografia , Neoplasias Cardíacas , Procedimentos Cirúrgicos Cardíacos/métodos
9.
Fertil Steril ; 107(2): 502-509, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27887708

RESUMO

OBJECTIVE: To compare hormonal and clinical responses to GnRH pulsatile treatment in weight-recovered anorexia nervosa patients (Rec-AN) with persistent functional hypothalamic amenorrhea (HA) vs. in patients with secondary and primary HA. DESIGN: Retrospective, observational, ambulatory study. SETTING: University hospital. PATIENT(S): Forty-one women: 19 Rec-AN (body mass index >18.5 kg/m2 without menses recovery), 15 secondary HA without any eating disorders patients (SHA), and 7 primary HA patients (PHA). INTERVENTION(S): Gonadotropin-releasing hormone pulsatile therapy. MAIN OUTCOME MEASURE(S): Baseline E2, LH, and P plasma levels and their changes during induction cycles; ovulation, follicular recruitment, and pregnancies. RESULTS: The Rec-AN group displayed higher basal E2 and LH plasma levels after GnRH injection compared with SHA and PHA. Higher E2 and LH levels were observed during induction cycles in Rec-AN compared with SHA and PHA. Follicular recruitment was higher in Rec-AN. The ovulation rate was higher in Rec-AN compared with PHA but similar to SHA. CONCLUSION(S): This study showed increased gonadal status and higher E2 response to pulsatile GnRH therapy in persistent amenorrheic weight-recovered AN compared with HA from other causes. It suggests that their individual set-point of body weight allowing a fully functional gonadal axis is not reached yet. Specific factors of gonadal inertia in Rec-AN still remain unclear.


Assuntos
Amenorreia/terapia , Anorexia Nervosa/terapia , Fármacos para a Fertilidade Feminina/administração & dosagem , Hormônio Liberador de Gonadotropina/administração & dosagem , Ciclo Menstrual/efeitos dos fármacos , Ganho de Peso , Adulto , Amenorreia/diagnóstico , Amenorreia/etiologia , Amenorreia/fisiopatologia , Anorexia Nervosa/complicações , Anorexia Nervosa/diagnóstico , Anorexia Nervosa/fisiopatologia , Biomarcadores/sangue , Estradiol/sangue , Feminino , Fármacos para a Fertilidade Feminina/efeitos adversos , Hormônio Liberador de Gonadotropina/efeitos adversos , Hospitais Universitários , Humanos , Infusões Subcutâneas , Hormônio Luteinizante/sangue , Ovulação/efeitos dos fármacos , Gravidez , Taxa de Gravidez , Progesterona/sangue , Pulsoterapia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
10.
J Adolesc Health ; 60(4): 469-471, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27998699

RESUMO

PURPOSE: The purpose of this study was to determine whether a history of overweight, weight suppression, and weight gain during treatment have an effect on return of menses (ROM) in adolescents with eating disorders (EDs). METHODS: Retrospective chart review of female adolescents presenting to an ED program from January 2007 to June 2009. RESULTS: One hundred sixty-three participants (mean age, 16.6 ± 2.1 years) met eligibility criteria. The mean median body mass index percent at ROM for those previously overweight was 106.1 ± 11.7 versus 94.2 ± 8.9 for those not previously overweight (p < .001). Both groups needed to gain weight for ROM. Greater weight suppression (odds ratio, 0.90; 95% confidence interval, 0.84-0.98; p = .013) was associated with lower likelihood of ROM, and greater weight gain during treatment (odds ratio, 1.20; 95% confidence interval, 1.07-1.36; p = .002) was associated with higher likelihood of ROM in those not previously overweight. CONCLUSIONS: Previously overweight amenorrheic patients with EDs needed to be at a higher median body mass index percent for ROM compared to those who were not previously overweight.


Assuntos
Amenorreia/etiologia , Índice de Massa Corporal , Transtornos da Alimentação e da Ingestão de Alimentos/complicações , Sobrepeso/complicações , Adolescente , Amenorreia/psicologia , Amenorreia/terapia , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Feminino , Humanos , Sobrepeso/psicologia , Estudos Retrospectivos , Ganho de Peso/fisiologia , Perda de Peso/fisiologia
11.
Pediatr Ann ; 45(3): e97-e102, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27031318

RESUMO

Functional hypothalamic amenorrhea is a diagnosis of exclusion that is common in female athletes, particularly those participating in aesthetic sports (ballet, other dance genres, figure skating, and gymnastics) and endurance sports (cross-country running). Although common, it should be considered abnormal even in the high-level elite athlete. Amenorrhea in combination with low energy availability and low bone density is labeled "the Female Athlete Triad." Studies have demonstrated numerous long-term consequences of athletes suffering from all or a portion of this triad, including increased rate of musculoskeletal injuries, stress fractures, abnormal lipid profiles, endothelial dysfunction, potential irreversible bone loss, depression, anxiety, low self- esteem, and increased mortality. This article provides the clinician with the tools to evaluate an athlete with secondary amenorrhea, reviews the recommended treatment options for affected athletes, and discusses when to return to the activity in an effort to facilitate "healthy" participation.


Assuntos
Amenorreia/etiologia , Síndrome da Tríade da Mulher Atleta , Esportes/fisiologia , Adolescente , Amenorreia/diagnóstico , Amenorreia/psicologia , Amenorreia/terapia , Terapia Combinada , Feminino , Síndrome da Tríade da Mulher Atleta/diagnóstico , Síndrome da Tríade da Mulher Atleta/etiologia , Síndrome da Tríade da Mulher Atleta/psicologia , Síndrome da Tríade da Mulher Atleta/terapia , Humanos , Volta ao Esporte , Esportes/psicologia
12.
Eur J Obstet Gynecol Reprod Biol ; 198: 131-137, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26849039

RESUMO

Functional hypothalamic amenorrhoea (FHA) is a neuroendocrine disorder caused by an energy deficit and characterized by low leptin levels. Based on this, previous studies have suggested that leptin administration may play a crucial role in FHA treatment. However, FHA is also associated with abnormal psychosocial and dietary behaviour that needs to be addressed. In this context, this systematic review examined the efficacy of leptin treatment, non-pharmacological therapy and nutritional interventions in FHA. PubMed, Medline and Cochrane Library databases were searched in order to find relevant papers, including randomized controlled trials, clinical trials, prospective studies and case reports. The effects of different treatments on reproductive function, hormonal status and bone markers were recorded. Studies regarding other forms of treatment were excluded. In total, 111 papers were retrieved. After the removal of 29 duplicate papers, the abstracts and titles of 82 papers were examined. Subsequently, 53 papers were excluded based on title, and seven papers were omitted based on abstract. The remaining 11 papers were used: three based on leptin treatment, three regarding non-pharmacological treatment and five regarding dietary intervention. This literature review indicates that all of these treatment strategies improved reproductive function and hormonal status significantly, although conclusive results could not be drawn on bone markers. While leptin may be a promising new treatment, social aspects of FHA should also be addressed. As a result, a multifaceted therapeutic approach should be applied to treat affected women.


Assuntos
Amenorreia/terapia , Aconselhamento , Ingestão de Energia , Doenças Hipotalâmicas/terapia , Leptina/uso terapêutico , Feminino , Humanos
13.
Bone Marrow Transplant ; 50(12): 1551-6, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26237168

RESUMO

Data are limited regarding the prevalence of menstrual cycles and pregnancies after high-dose chemotherapy (HDC) and auto-stem cell transplantation (SCT). Female patients who underwent HDC auto-SCT for non-Hodgkin and Hodgkin lymphoma (1997-2012) were reviewed. The selection criteria were as follows: (1) alive without disease 12 and 24 months after auto-SCT for menstrual cycles and pregnancy, respectively, (2) age <40 years at auto-SCT, and (3) no primary infertility. One-hundred and seventy-six females underwent single auto-SCT. Eighty-nine were eligible for menstrual cycles and pregnancy analysis. Median age at auto-SCT was 25 years (14-40 years), at pregnancy 27 years (20-37 years), median follow-up 65 months (range 24-190). Regular menstrual-cycles resumed in 56/89 patients (63%). Increasing age (P=0.02) and number of prior chemotherapy cycles (P=0.02) are associated with higher risk of amenorrhea. Forty patients tried to get pregnant, 26 (65%) became pregnant 50 times: 43 (86%) live birth, 7 (14%) miscarriage and 2/50 had birth defects. Twenty-four patients practiced breastfeeding (median duration 4 months (1-24 months)). Enough breast milk production was reported 62.5% vs 100% in those patients who did or did not receive above the diaphragm radiation therapy, respectively, (P=0.066). Our data highlights significantly higher than perceived incidence of menstrual cycle resumption, successful pregnancies and breastfeeding after HDC auto-SCT.


Assuntos
Antineoplásicos/administração & dosagem , Doença de Hodgkin/terapia , Nascimento Vivo , Linfoma não Hodgkin/terapia , Ciclo Menstrual , Complicações Neoplásicas na Gravidez/terapia , Transplante de Células-Tronco , Adulto , Amenorreia/etiologia , Amenorreia/terapia , Antineoplásicos/efeitos adversos , Autoenxertos , Feminino , Humanos , Gravidez , Estudos Retrospectivos
14.
Endokrynol Pol ; 66(3): 252-60, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26136135

RESUMO

Functional hypothalamic amenorrhoea (FHA) is associated with functional inhibition of the hypothalamic-pituitary-ovarian axis. Causes of FHA can be classified into the three groups: 1) stress-related factors, 2) consequences of weight loss and/or underweight, and 3) consequences of physical exercise or practicing sports. Diagnosis of FHA should be based on a history of menstrual disorders. During physical examination, patients with FHA present with secondary and tertiary sex characteristics specific for the pubertal stage preceding development of the condition and with the signs of hypoestrogenism. Laboratory results determine further management of patients with amenorrhea, and thus their correct interpretation is vital for making appropriate therapeutic decisions. Treatment of chronic anovulation, menstrual disorders, and secondary amenorrhea resulting from hypothalamic disorders should be aimed at the elimination of the primary cause, i.e. a decrease in psycho-emotional strain, avoidance of chronic stressors, reduction of physical exercise level, or optimisation of BMI in patients who lose weight. If menses do not resume after a period of six months or primary causative treatment is not possible, neutralisation of hypoestrogenism consequences, especially unfavourable effects on bone metabolism, become the main issue. Previous studies have shown that oestroprogestagen therapy is useful in both the treatment of menstrual disorders and normalisation of bone mineral density. Hormonal preparations should be introduced into therapeutic protocol on an individualised basis.


Assuntos
Amenorreia/diagnóstico , Doenças Hipotalâmicas/diagnóstico , Adolescente , Adulto , Amenorreia/etiologia , Amenorreia/terapia , Feminino , Humanos , Doenças Hipotalâmicas/etiologia , Doenças Hipotalâmicas/terapia , Adulto Jovem
15.
J Pediatr Adolesc Gynecol ; 28(3): e87-90, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25817766

RESUMO

BACKGROUND: Congenital cervical fragmentation is a very rare genital tract malformation that usually presents in adolescence with primary amenorrhea and cyclic, monthly, lower abdominal pain. We report a nearly normal case of congenital cervical fragmentation and successful end-to-end anastomosis. CASE: A 15-year-old girl presented with primary amenorrhea with cyclic, monthly lower abdominal pain lasting for 15 months without any abnormal imaging findings (pelvic CT scan, ultrasonography, and hysteroscopy). Misdiagnosis and appendectomy was performed at the time of the initial lower abdominal pain. Diagnostic combined hysteroscopy and laparoscopy were performed in our hospital, and cervical fragmentation was diagnosed. A converted laparotomy end-to-end anastomosis was performed successfully, and regular menstruation was restored after the operation. SUMMARY AND CONCLUSION: The malformation of nearly normal congenital cervical fragmentation is existent and hard to diagnose. As long as the patient has persistent primary amenorrhea with cyclic, monthly lower abdominal pain, even if no abnormal findings on imaging, obstructive malformation of the reproductive duct should be the primary suspicion. Diagnosis and treatment should occur as early as possible to preserve the patient's fertility. End-to-end anastomosis is the best method for this type of patient.


Assuntos
Colo do Útero/anormalidades , Colo do Útero/cirurgia , Dor Abdominal/etiologia , Adolescente , Amenorreia/etiologia , Amenorreia/terapia , Feminino , Humanos , Histeroscopia , Laparoscopia , Menstruação , Gravidez
16.
Obstet Gynecol Clin North Am ; 42(1): 27-37, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25681838

RESUMO

Before initiating ovulation induction, it is important to evaluate the underlying cause of a patient's anovulation and to make lifestyle modifications or treat underlying medical conditions, as appropriate. Here, ovulation induction agents are discussed with attention to their pharmacology, indications for use, therapy regimens, and efficacy. Adjuvant therapies and appropriate monitoring are also reviewed.


Assuntos
Amenorreia/terapia , Anovulação/tratamento farmacológico , Hipogonadismo/terapia , Infertilidade Feminina/terapia , Indução da Ovulação/métodos , Síndrome do Ovário Policístico/terapia , Amenorreia/etiologia , Anovulação/etiologia , Clomifeno/uso terapêutico , Estrogênios/uso terapêutico , Feminino , Fármacos para a Fertilidade Feminina/uso terapêutico , Gonadotropinas/uso terapêutico , Humanos , Hipogonadismo/complicações , Infertilidade Feminina/etiologia , Indução da Ovulação/tendências , Síndrome do Ovário Policístico/complicações , Gravidez , Progestinas/uso terapêutico
17.
Best Pract Res Clin Obstet Gynaecol ; 29(4): 516-27, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25467426

RESUMO

Obese women often present with oligomenorrhoea, amenorrhoea or irregular periods. The association between obesity and heavy menstrual bleeding is not well documented and data on its prevalence are limited. While the investigation protocols should be the same as for women of normal weight, particular focus is required to rule out endometrial hyperplasia in obese women. The treatment modalities of menstrual disorders for obese women will be, in principle, similar to those of normal weight. However, therapeutic outcomes in terms of effectiveness and adverse outcomes need special consideration when dealing with women with a high body mass index (BMI). Here, different treatment strategies are reviewed paying particular attention to the effect of weight on their efficacy and the challenges of providing each treatment option. This chapter aims to review the current literature and address areas where further evidence is needed, which will subsequently influence clinical practice.


Assuntos
Anticoncepcionais Orais Combinados/uso terapêutico , Técnicas de Ablação Endometrial , Estrogênios/metabolismo , Dispositivos Intrauterinos Medicados , Acetato de Medroxiprogesterona/uso terapêutico , Distúrbios Menstruais/terapia , Obesidade/metabolismo , Progestinas/uso terapêutico , Amenorreia/epidemiologia , Amenorreia/metabolismo , Amenorreia/terapia , Anticoncepcionais Femininos/uso terapêutico , Hiperplasia Endometrial/epidemiologia , Hiperplasia Endometrial/metabolismo , Hiperplasia Endometrial/terapia , Feminino , Humanos , Histerectomia , Menorragia/epidemiologia , Menorragia/metabolismo , Menorragia/terapia , Distúrbios Menstruais/epidemiologia , Distúrbios Menstruais/metabolismo , Obesidade/epidemiologia , Oligomenorreia/epidemiologia , Oligomenorreia/metabolismo , Oligomenorreia/terapia , Prevalência
20.
Obstet Gynecol Surv ; 69(10): 603-12, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25336070

RESUMO

Puberty is a defining time of many adolescents' lives. It is a series of events that includes thelarche, pubarche, and menarche. Primary amenorrhea is the absence of menarche. There are numerous etiologies including outflow tract obstructions, gonadal dysgenesis, and anomalies of the hypothalamic axis. This review's aims are to define primary amenorrhea and describe the various causes, their workups, associated comorbidities, and treatment options. At the end, a generalist should be able to perform an assessment of an adolescent who presents with primary amenorrhea and, if warranted, begin initial treatment.


Assuntos
Amenorreia/etiologia , Amenorreia/terapia , Genitália Feminina/anormalidades , Disgenesia Gonadal/complicações , Ovário/anormalidades , Doenças da Hipófise/complicações , Adeno-Hipófise , Adolescente , Amenorreia/diagnóstico , Feminino , Disgenesia Gonadal/diagnóstico , Disgenesia Gonadal/terapia , Humanos , Doenças da Hipófise/diagnóstico , Doenças da Hipófise/terapia , Síndrome do Ovário Policístico/complicações , Síndrome do Ovário Policístico/terapia
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