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Vitamin D deficiency is considered a major public health problem worldwide and has been reported as having an association with depression. However, studies on the association between vitamin D deficiency and depressive symptoms in secondary amenorrhea (SA) patients are still scarce. This study examined the relationship between serum 25-hydroxyvitamin D (25(OH)D) levels and depressive symptoms among Korean women with SA. In this cross-sectional observational study, 78 patients with SA were initially recruited. Clinical and biochemical parameters, including serum 25(OH)D level, were measured. Data from 63 SA patients who met the study inclusion criteria and completed psychiatric assessments were finally analyzed. We analyzed their association with depression using a hierarchical regression model. The average serum 25(OH)D level was 34.40 ± 24.02 ng/mL, and 41.3% of the women with SA were vitamin D-deficient (

This is a pictorial review on the radiological approach to patients with amenorrhea using a level-based framework. The prevalence of amenorrhea is 3 to 4% with wide-ranging causes involving multiple clinical disciplines. Normal menstruation depends on complex coordinated hormonal functions of the hypothalamic-pituitary-ovarian axis exerting its effect on an intact uterine end-organ and outflow tract. A disruption of any of these factors may result in amenorrhea. Categorizing the causes of primary and secondary amenorrhea into uterine, ovarian/gonadal, and intracranial levels provides a logical framework for its evaluation. A systematic level-based approach by targeted ultrasound of the pelvic structures is suggested, with different aims in primary versus secondary amenorrhea. Pelvic sonographic findings of various conditions within the uterine and ovarian/gonadal levels are illustrated. Conditions due to an intracranial cause result in downstream effects on the uterus and ovaries and can often be suspected based on a combination of clinical assessment, ultrasound findings, and laboratory investigations. By correlating pelvic ultrasound findings with underlying pathology, the clinical radiologist is able to provide useful diagnostic information in the management of these patients.

This study aimed to determine the prevalence of female athlete triad risk factors among female international volunteers based on the development and income status of their country of service. A total of 2164 past volunteers completed a retrospective survey. Countries’ income and development statuses were coded using the respective annual United Nations World Economic Situations and Prospects reports. Independent t-tests, ANOVAs, and Pearson’s Chi-Squared tests were used to assess group differences; corresponding odds ratios were calculated. Volunteers in nondeveloped (OR = 2.25, CI = 1.85–2.75) and non-high-income (OR = 2.17, CI = 1.75–2.70) countries had over twice the odds of experiencing secondary amenorrhea. More volunteers who served in nondeveloped countries reported an increase in exercise while serving (p = 0.005). Those who served in a nondeveloped (OR = 1.52, CI = 1.16–1.98) or non-high-income (OR = 1.45, CI = 1.08–1.94) country had higher odds of weight loss. However, volunteers serving in nondeveloped (OR = 0.52, CI = 0.44–0.63) and non-high-income (OR = 0.50, CI = 0.4–0.61) countries were less likely to report food insecurity compared to those in developed and high-income countries. Bone mineral density was within the expected range regardless of income and development status. Female volunteers who served in nondeveloped and non-high-income countries experienced higher odds of secondary amenorrhea, which was likely influenced by an increase in exercise and higher odds of weight loss.

Aim of the work: To detect the frequency of secondary amenorrhea in a cohort of Egyptian systemic lupus erythematosus (SLE) patients and to identify potentially related key-players. Patients and methods: The medical records of 140 adult SLE patients above 18 and less than 40 years were revised regarding clinical characteristics, immunological features and medications received. The SLE disease activity index (SLEDAI) and damage index (SLICC-DI) were recorded. Patients were divided into two groups: patients who developed secondary amenorrhea and those having normal menstrual cycles. Results: The mean age of the patients was 26.8 ± 5.7 years, the median disease duration was 3.5 years. The patients had renal involvement in 69.3%, neuropsychiatric in 23.6% and cardiac in 37.9%. Cyclophosphamide (CYC) was received by 52.1% and steroids by 139 patients. Secondary amenorrhea was found in 44 patients (31.4%); 36 (81.8%) of them were ≤32 years old. Patients with secondary amenorrhea had a higher frequency of positive anti-double stranded deoxyribonucleic acid (ds-DNA) antibodies (75% vs 50%; p = 0.04) and a shorter disease duration (median 2 years vs 4.5 years; p = 0.005). Lupus nephritis, renal failure, neuropsychiatric manifestations, cardiac involvement and receiving CYC and high-dose steroids tended to be more frequent in those with secondary amenorrhea compared to those without. The median SLICC-DI was higher in those with amenorrhea compared to those without (p = 0.2) Conclusion: Cyclophosphamide is not the only key-player for the development of secondary amenorrhea in SLE; other factors as the shorter disease duration, presence of autoantibodies and major organ involvements may be implicated. Keywords: Systemic lupus erythematosus, Secondary amenorrhea, Egyptian, Disease duration, Anti ds-DNA

Purpose A clinical case presenting secondary amenorrhea accompanied by an adrenal adenoma and hyperprogesteronemia is described in this study. Methods Selective catheterization and sampling of adrenal and ovarian veins were performed. Results The source of hyperprogesteronemia was located in the right adrenal gland. A progesterone-producing tumor in the right adrenal gland was diagnosed and removed. Twenty-six days after tumor resection, menstruation occurred. Conclusions Progesterone-producing tumors should be considered with the presence of an adrenal mass and hyperprogesteronemia. Combined adrenal and ovarian venous sampling may help to identify the source of progesterone secretion.

Resumen: La anovulación ocurre en el 30 % de la Infertilidad y la amenorrea secundarla en el 4% de mujeres en edad reproductiva. Ambas alteraciones se pueden tornar crónicas conllevando riesgos de hiperestrogenismo e hipoestrogenismo crónicos. Tanto la anovulación como la amenorrea secundaria tienen las mismas causas endocrinas, excepto que la amenorrea tiene una adicional de causa uterina. No obstante existen muchas clasificaciones etiológicas, unas combinan la amenorrea secundaria con la primaria, otras se enfocan más a la anovulación y algunas agrupan las etiologías en compartimentos, sin lograr hacerlo en forma integral. El objetivo es revisar las clasificaciones etiológicas de anovulación y amenorrea secundaria, junto con la actualización de cada una de esas causas, a fin de seleccionar la clasificación que las agrupe integralmente para enfocar el manejo en forma fácil y práctica. Para ello, se revisó la literatura médica reciente en libros de texto, PubMed, Ovid, Clinical guidelines y Cochrane library, con palabras claves. Se concluye que la clasificación etiológica integral en cinco compartimentos es una guía fácil de seguir, para lograr el diagnóstico de cada una de esas causas, actualmente, cuando existen medicamentos y procedimientos quirúrgicos seguros para manejarlas como anovulación o como amenorrea secundaria. Abstract: Anovulation occurs in 30% of infertility and secondary amenorrhea In 4% of women In reproductive age. Both alterations can become chronic, carrying risks of chronic hyperestrogenism and hypoestrogenism. Both anovulation and secondary amenorrhea have the same endocrine causes, except that amenorrhea has an additional uterine cause. However, there are many etiological classifications, some combine secondary and primary amenorrhea, others focus more on anovulation and some group the etiologies into compartments, without achieving a comprehensive approach. The objective is to review the etiological classifications of anovulation and secondary amenorrhea, together with the update of each one of these causes, in order to select the classification that can integrally groups them so that to their management can be focused on an easy and practical way. For this purpose, recent medical literature in textbooks, PubMed, Ovid, Clinical guidelines and Cochrane library was reviewed with key words. It is concluded that the comprehensive etiological classification in five compartments is an easy guide to follow to achieve the diagnosis of each of these causes, currently, when there are drugs and safe surgical procedures to manage them as anovulation or secondary amenorrhea. Resumo: A anovulação ocorre em 30 % da Infertilidade e a amenorreia secundária em 4 % de mulheres em idade reprodutiva. Ambas as alterações podem se tornar crônicas, implicando riscos de hiperestrogenismo e hipoestrogenismo crônicos. Tanto a anovulação quanto a amenorreia secundária têm as mesmas causas endócrinas, exceto que esta última tem ainda causa uterina. Contudo, existem muitas classificações etiológicas, umas combinam a amenorreia secundária com a primária, outras se focam mais na anovulação, e algumas agrupam as etiologias em compartimentos sem poder fazer isso de forma integral. O objetivo é revisar as classificações etiológicas de anovulação e amenorreia secundária, junto com a atualização de cada uma dessas causas, a fim de selecionar a classificação que as agrupe integralmente para focar o manejo de forma fácil e prática. Para isso, foi revisada a literatura médica recente em textos consultados em PubMed, Ovid, Clinical guidelines e Cochrane library, a partir de palavras-chave. Conclui-se que a classificação etiológica integral em cinco compartimentos é um guia fácil de seguir para obter o diagnóstico de cada uma dessas causas, atualmente, quando existem medicamentos e procedimentos cirúrgicos seguros para manejá-las como anovulação ou como amenorreia secundária.

This article provides an approach to amenorrhea and is intended for pre-clinical and clerkship medical students. Primary amenorrhea refers to the absence of menarche by 15 years or 3 years post thelarche while secondary amenorrhea is the cessation of menses for 3 months in women with a previously regular cycle or for 6 months in women with previously irregular menses. While amenorrhea can be physiological it can also reflect an anatomical or more complex hormonal problem that students must learn to identify and investigate.

Highlights • Vesicouterine fistula is pathological communication between the bladder and uterus or cervix. • Symptoms of VUF were secondary amenorrhea and cyclic hematuria with history of previous cesarean section (concluded as Youssef’s syndrome). • Surgical approach is contemplated as definitive management of the VUF following caesarean section. • A group of women was able to have normal period after fistula repair., Vesicouterine fistula (VUF) is an abnormal communication between the bladder and uterus, occurring 1–4% of all urogenital fistulas. Diagnosis is still a challenge because symptoms may appear late or fistula may be missed even after repeated examination. A 37-year old woman who has two children born through caesarean section complained of the absence of menstruation for the past three years. At the same time point, she experienced cyclic haematuria and amenorrhea. The diagnosis was made through ultrasonography, cystoscopy and hysteroscopy. She was then managed with laparoscopic bladder fistula repair continued with total laparoscopic hysterectomy. The VUF can present as an undesirable consequence of caesarean section.

Secondary amenorrhea is not uncommon in the adolescent female population. There are multiple etiologies to consider, and a comprehensive evaluation is often pursued. Sometimes, however, despite a thorough workup, the diagnosis remains unclear. Here, we report an unusual cause of secondary amenorrhea in a 15-year-old girl. Our patient presented with secondary amenorrhea after a 4-year history of regular menstrual cycles. Her evaluation was notable for very low FSH and low estradiol but normal LH; pregnancy, adrenal, thyroid, prolactin studies, and brain magnetic resonance imaging scan did not reveal a cause of her amenorrhea. Her transabdominal ultrasound showed an enlarged right ovary, initially suggestive of a hemorrhagic cyst. Inhibin A and B were measured because of the persistently low FSH; these were found to be very elevated, concerning for an inhibin-producing tumor. The patient had surgical removal of her right ovary; pathology revealed a juvenile granulosa-cell tumor. Postoperatively, the patient had normalization of serum inhibin A and B and resumption of normal menstrual cycles. This report illustrates that careful consideration of laboratory findings and other studies is essential for correctly identifying the underlying cause of secondary amenorrhea, particularly when the results are not consistent with common causes of this condition.

The treatment of persistent uterine bleeding in those patients who identify as transmasculine or nonbinary is often straightforward, but can be difficult in a subset of patients. This article reviews the physiology of the normal menstrual cycle and the hormonal influences on the endometrium, and then explores options for the treatment of persistent bleeding for people both already on testosterone and for those who are either not ready for or who do not desire testosterone.

Disruptions in the menstrual cycle are a common complaint in primary care and women's health. Irregular or absent menstrual periods should trigger an evaluation to identify the root cause. This article discusses secondary amenorrhea and provides a systematic approach to its diagnostic evaluation, with referral considerations.

Background: Secondary amenorrhea is a condition when period cycle of women with irregular menstruation disappeared within six months in a row or; when the period cycle of regular menstruation women disappeared during three months in a row. In Traditional Chinese Medicine (TCM), amenorrhea is known as Jing Bi. The patient in this study case was having secondary amenorrhea with menstrual complaints not within 3 months and 22 days after the last periods. Patient was classified as secondary amenorrhea with differentiation of Qi and blood deficiency syndrome. Purpose: To know the effect of acupuncture therapy with Sanyinjiao point (SP6), Taichong point (LR3), Zusanli point (ST36), Gui lai point (ST 29) combined with turmeric herbal therapy (Curcuma domestica Val) and klabet seed (Trigonella foenum-graecum L.) in patients with secondary amenorrhea. Methods: Treatment of this secondary amenorrhea case was using acupuncture and herbal therapy. Acupuncture therapy at acupoint Sanyinjiao (SP6), Taichong (LR3), Zusanli (ST36), and Gui Lai (ST29) with tonification principle of Qi and blood and improve menstrual flow. The herbal therapy given were turmeric (Curcuma domestica Val) and fenugreek seeds (Trigonellafoenum-graecum L.), which has estrogenic effect. Results: Estrogen stimulates the lining of the uterus to remove the menstrual blood. In the treatment of secondary amenorrhea, acupuncture therapy was given 21 times, three times a week. Herbal therapy was given for 60 days, taken 2 times a day with dose of 15 grams of turmeric and 4 grams of fenugreek seeds. This therapy might help the menstrual blood exuviation. Conclusion: Acupuncture and herbal therapy can be applied continously to the patient up until regular period cycle are attained.

Based on the survey results of January - April 2017 aksetor number of injections 3 months in Midwives BPM "S" Curug Tangerang as many as 425 people. From the data obtained acceptor injections three months did not experience any side effects that 23%, and who experience side effects from injections of 3 months as many as 77%, consisting of amenorrhea were 75 %, which experienced a weight gain as many as 19.5%, and those with spoting 5.5%. The purpose of this research is to describe the characteristics of 3-month injectable acceptors with secondary amenorrhea by age, parity, KB long, long experienced menstrual disorders. The methodology in this paper uses descriptive method types. The place is BPM Midwives "S" Curug Tangerang. The study design used is Cross Sectional. With a population of 315 people. Large samples taken 76 respondents and retrieval techniques samplenya with "Non-Probability Sampling" method used was "accidental sampling". Data collected by the secondary data through medical records. Analysis of the data used univariate analysis. The results obtained are based on age, 76 more than half sebayak 56 people aged 20-35 (73.7%). Based on parity, more than half of the 76 acceptors grande multipara many as 48 people (63.1%). Based on the old family planning with a long of 76 half berKB ≥ 24 months as many as 41 people. Based on long experience disruption of 76 is less than half as many menstrual disorders 6-10 years as many as 31 people.

The aim of this report was to define the best diagnostic and therapeutic approach when secondary amenorrhea is related to undiagnosed Asherman syndrome. We present a single case of secondary amenorrhea with a previous diagnosis of alterated hypothalamic-hypophysary regulation, with a component of ovarian function in probable reduction, which was evaluated in our department and resulted affected by Asherman's syndrome IV stage. We describe step by step the diagnosis and treatment of a previously misdiagnosed case of severe Asherman's syndrome. An appropriate diagnosis and adequate treatment are mandatory to allow menses and fertility to be restored when severe Asherman's syndrome occurs.

Background Amenorrhea is the absence of menstrual periods. It has multiple social consequences as it may leads to infertility. This case control study was conducted for determining the association of thyroid hormones with hyperprolactinemia in patient with amenorrhea. Methods We investigated 50 women with diagnosed cases of secondary amenorrhoea, who attended UCMS hospital, for hormonal evaluations. Fifty two healthy women were taken as the controls. The thyroid dysfunction and serum prolactin level were reviewed in cases and in the controls. Results Mean serum prolactin level was found to be significantly higher in the cases as compared to the controls. Mean serum fT3 and fT4 level in the hyperprolactinemic cases (mean = 2.67, SD = 1.04 pg/ml) and (mean = 1.38, SD = 0.51 ng/dl respectively) were slightly lower as compared to normoprolactinemic cases (mean = 3.21, SD = 1.86 pg/ml) and (mean = 1.73, SD = 1.37 ng/dl) respectively. Mean TSH of normoprolactinemic and hyperprolactinemic cases were comparable (P = 0.049). There was positive correlation between prolactin, BMI and TSH whereas negative correlation of prolactin was seen with fT3, fT4 and age. In hyperprolactainemic cases, prolactin was found to be negatively correlated with TSH (r = -0.155, P = 0.491) whereas prolactin was positively correlated with TSH (r = 0.296, P = 0.126) in normoprolactainemic cases. Conclusions Thus, hyperprolactinemia with thyroid dysfunction may be contributory hormonal factor in patient with amenorrhoea and as such, estimation of prolactin, fT3, fT4 and TSH should be included for diagnostic evaluation of amenorrhea.

Tuberculosis (TB) is a disease which can affect various organs, including human's genital organs such as the endometrium. Tuberculosis endometritis can cause clinical symptoms of secondary amenorrhea and infertility. Infertility in genital TB caused by the involvement of the endometrium. The case presentation is 33-year-old woman from dr. Saiful Anwar Public Hospital to consult that she has not menstruated since 5 years ago (28 years old). The diagnosis was done by performing a clinical examination until the diagnosis of secondary amenorrhea due to tuberculosis endometritis is obtained. A treatment by using category I of anti-tuberculosis drugs was done for 6 months, afterward an Anatomical Pathology observation found no signs of the tuberculosis symptoms. Based on that, patient, who was diagnosed to have secondary amenorrhea due to tuberculosis endometritis, has no signs of tuberculosis process after being treated by using category I of anti-tuberculosis drugs for 6 months.Pan African Medical Journal 2016; 24

Background Imperforate hymen prevents menstrual blood drainage, which causes cyclic lower abdominal pain and amenorrhea. Untreated patients might develop serious complications such as endometriosis and infertility. Hymenectomy represents the adequate treatment. Case In a 16-year-old female virgin presented with recurrent lower abdominal pain, urine retention, and secondary amenorrhea after 3 hymenectomy surgeries. The examination revealed imperforate hymen. A fourth hymenectomy was performed with continuous locked sutures over all of the edges. Summary and Conclusion Recurrent imperforate hymen after hymenectomy should be suspected if symptoms recur. Diagnosis can be achieved through meticulous clinical examination and appropriate imaging techniques.

To evaluate whether neuroendocrine forms of secondary amenorrhea (hypothalamic nervosa (HA) and anorexia nervosa (AN)) affect serum anti-Müllerian hormone (AMH), inhibin B, and total inhibin levels.Amenorrheic women (n = 82) (aged between 16 and 35 years old) according to diagnosed with neuroendocrine forms of amenorrhea: HA (n = 64), AN (n = 18), and healthy women (n = 41) (control group) were enrolled. Serum AMH, inhibin B, and total inhibin levels were measured by specific ELISA.No statistically significant difference of AMH serum levels between women with HA, AN, and control group was observed. Serum inhibin B and total inhibin levels in women with HA (p 0.0001), AN (p 0.05) resulted significantly lower than in control healthy women.The present data showed that neuroendocrine forms of amenorrhea are associated with an impaired inhibin secretion while not AMH. These data indirectly support that AMH is an excellent marker of ovarian reserve and its secretion is not influenced by the hypothalamic-ovarian axis activity.

Aims: We attempted to determine the future recovery rate of normal menstrual cycles in adolescents with secondary amenorrhea. We also attempted to determine the difference in recovery rate between patients with and without etiological factors for amenorrhea, and between those with first- and second-degree secondary amenorrhea. Methods: We conducted questionnaire-based analysis of 35 patients with adolescent secondary amenorrhea. When the patients were over 20 years old, we obtained information as to the present menstruation status and the history of pregnancy. Results: Seventy-four percent of patients recovered their normal menstrual cycles after the age of 20. The recovery rate was significantly higher in patients with etiological factors (93%) than in those without (60%: P = 0.02). There was a trend towards a higher recovery rate in those with second-degree compared with first-degree amenorrhea, but this was not statistically significant. Conclusions: Three-quarters of adolescent patients with secondary amenorrhea recovered their normal menstrual cycles. The initial presence of etiological factors for amenorrhea raised the recovery rate. This data provides useful prognostic information for health providers taking care of adolescents with secondary amenorrhea.

Objective A preliminary study to evaluate the usefulness of homeopathic treatment in the care of menstrual irregularities. Method Patients were diagnosed at the first appointment according to menstrual cycle over the past year: Amenorrhea (AM), Oligo-amenorrhea (OL-AM), OL, Taking hormone replacement therapy (HRT). All patients were prescribed an individualised, global homeopathic treatment. The main outcomes were: time to resumption of periods, change of clinical diagnosis at the end of follow-up or after 2 years. The secondary outcomes were: menstrual regularity at the end of follow-up, compared to pre-treatment frequency; flow characteristics; clinical course of acute and chronic concomitant symptoms. Results 18 consecutive cases of secondary amenorrhea (SA) and oligomenorrhea (OL) met the entry criteria. 8 women had SA, 2 were on HRT, 6 had OL-AM and 2 had OL. The average duration of considered follow-up was 21 months. The average time before the reappearance of menstruation was 58 days (s.d. 20) in the 8 women with SA at the time of the first appointment, for all cases 46 days (s.d. 42). Change of clinical diagnosis: 50% of women, who were diagnosed AM, recovered their ovulatory cycle (OV), whereas 12.5% remained amenorrheic; 33.3% of patients, who were initially OL-AM, showed an OV; 100% of oligomenorrheic and HRT patients recovered an OV. The average frequency of spontaneous cycles per year changes from 4.32 (s.d. 1.97) pre-treatment to 9.6 cycles per year at the end (s.d. 2.92). Four detailed case histories are reported.

We describe a new case of partial deletion of the long arm of the X chromosome, found in a 24-year-old female with secondary amenorrhea; the karyotype of the proposita is 46, X, del(X)(q22). We take this opportunity to review the previously published descriptions of non-mosaic structural anomalies of the X chromosome (X isochromosomes excepted), with the goal of “testing” the recent hypotheses formulated about: (a) the existence of an X inactivation center (Therman et al. 1974b); (b) the presence of a “b” segment remaining active on Xp (Therman et al. 1976); (c) the potential importance of a critical area on Xq linked to gonadal function (Sarto et al. 1973); and (d) the presence of normal gonadal function despite an Xp terminal deletion (Fraccaro et al. 1977). We conclude that the above-mentioned theories, as well as those concerning phylogenetic evolution of sex chromosome morphology presented by Lyon (1974) and Hoo (1975), receive support from practically all of the 149 cases we compared. Regarding the features of the Turner syndrome, we propose “mapping” of the X chromosome as follows: the genes involved in gonadal function seem to be located on the proximal part of Xp and on the distal part of Xq, whereas the genes whose absence is responsible for somatic features of the syndrome may be distributed along the length of Xp and the middle section of Xq(q21-q26). Furthermore, we note some interesting analogies between the evolutionary model proposed by Hoo (1975) and the map we visualize.

Among secondary amenorrheas, hypothalamic amenorrhea (HA) is the one with no evidence of endocrine/systemic causal factors. HA is mainly related to various stressors affecting neuroendocrine control of the reproductive axis. In clinical practice, HA is mainly associated with metabolic, physical, or psychological stress. Stress is the adaptive response of our body through all its homeostatic systems, to external and/or internal stimuli that activate specific and nonspecific physiological pathways. HA occurs generally after severe stressed conditions/situations such as dieting, heavy training, or intense emotional events, all situations that can induce amenorrhea with or without body weight loss and HA is a secondary amenorrhea with a diagnosis of exclusion. In fact, the diagnosis is essentially based on a good anamnestic investigation. It has to be investigated using the clinical history of the patient: occurrence of menarche, menstrual cyclicity, time and modality of amenorrhea, and it has to be excluded any endocrine disease or any metabolic (i.e., diabetes) and systemic disorders. It is necessary to identify any stressed situation induced by loss, family or working problems, weight loss or eating disorders, or physical training or agonist activity. Peculiar, though not specific, endocrine investigations might be proposed but no absolute parameter can be proposed since HA is greatly dependent from individual response to stressors and/or the adaptive response to stress. This chapter aims to give insights into diagnosis and putative therapeutic strategies.

Objective: Here, we present a case of ACTH-dependent pituitary macroadenoma (Cushing's disease) resulting in secondary amenorrhea mimicking polycystic ovary syndrome (PCOS). Case Report: A 20-year-old nulligravid woman had been suffering from oligomenorrhea, amenorrhea, and moderate hirsutism since the age of 18 years. She visited a gynecologic clinic where PCOS was impressed according to the clinical manifestation and ultrasound finding. The patient responded to medication in the 1st year, but gradually failed to induce menses. She was advised to visit the endocrinology department for secondary amenorrhea and endocrine survey. Physical examination revealed central obesity, supraclavicle fatpad, abdominal striae, and myopathy of four limbs. Endocrine studies revealed: serum prolactin 21 ng/mL (3.0-20 ng/mL), FSH 5.69 mIU/mL (3.4-10.0 mIU/mL), LH 1.01 mIU/mL (1.1-11.6 mIU/mL), E2 < 20 pg/mL (follicular phase 53-258 pg/mL), ACTH 110 pg/mL (0-46.0 pg/mL), cortisol 26.7 μg/dL at 8 a.m. (5.0-25 μg/dL), cortisol 21.3 μg/dL at 11 p.m. (half of normal morning value). Right pituitary macroadenoma was diagnosed through a series of dexamethasone tests and MRI. The patient received staging surgery including transsphenoidal adenomectomy and right frontotemporal craniotomy. As a result, the patient's physical condition gradually improved, and her menstrual cycle became regular with medication after the operation in the outpatient follow-up. Conclusion: PCOS is a common disease resulting in secondary amenorrhea. However, Cushing's syndrome resulting from pituitary macroadenoma should also be considered. Therefore, a careful history, observation, physical examination, and endocrine studies can differentiate between patients with PCOS and Cushing's disease.

Background: Premature ovarian failure (POF) in adolescents is defined as primary or secondary amenorrhea associated with high follicle-stimulating hormone (FSH) levels. In normal 46,XX patients, its etiology is most often unknown. We have evaluated the clinical, hormonal and ovarian phenotypes in patients with a normal karyotype who were diagnosed with POF before the age of 18. Methods: Sixty-three patients were included in this retrospective study. Results: The mean patient age was 20.4 years. The patients presented with three clinical patterns: lack of pubertal development (n = 23), primary amenorrhea with interrupted puberty (n = 18), and secondary amenorrhea with normal puberty (n = 22). Ten patients had a familial history of POF and 6 presented with hypothyroidism. The FSH, estradiol and inhibin B levels were not statistically different in the three clinical groups. Fifty percent of the patients presented small ovaries (length Conclusion: 46,XX patients presenting with early POF rarely presented a specific, identifiable disorder. We discuss the clinical management and different diagnosis strategies to improve our current knowledge of this syndrome.

A complex mosaicism involving the X chromosome was found in a 35-year-old female affected by secondary amenorrhea and short stature. Her karyotype was: 45,X[20]/46,X,del(X)(pter-->q26::qter)[15]/46,X,idic(X)(pter-->q26::q26-->pter)[9]. No cell contained both abnormal X chromosomes. This observation would suggest a possible mechanism underlying the formation of isodicentric chromosomes.

Chronic hydrocephalus, most commonly the result of aqueduct stenosis, is associated with both primary and secondary amenorrhea. Only six cases of secondary amenorrhea have been reported to date. We describe a women with cystic fibrosis who presented with secondary amenorrhea as a consequence of Chiari-I malformation and resultant hydrocephalus. The biochemical picture was characterized by hypogonadotropic hypogonadism. Resolution of the amenorrhea was observed to occur following 3rd ventriculostomy.

Background Amenorrhea resulting from crushing trauma of the pelvis is exceptionally rare. The purpose of this case report is to describe the diagnosis of and successful surgical correction of traumatic separation of the cervix from the uterine corpus. Case A nulligravida presented with a complaint of secondary amenorrhea after a motor vehicle accident in which she sustained a crush-type injury to the pelvis. Ultrasonography and laparotomy revealed a complete separation of the uterine corpus from the cervix. The uterine corpus was approximated to the cervix with circumferentially placed sutures to establish a patent outflow tract from the endometrial cavity to the cervical canal. Conclusion This case demonstrates the successful surgical correction of secondary amenorrhea resulting from traumatic separation of the uterine corpus from the cervix. Normal menstruation resumed 6 weeks after surgery.

This study aimed at investigating the prevalence of osteopenia among a hypoestrogenic group of patients with primary or secondary amenorrhea. Twenty-seven patients with amenorrhea were examined. Sixteen of them presented with secondary amenorrhea (mean age 27.8 +/- 1.9 yrs), and 11 with primary amenorrhea (mean age 21.3 +/- 1.6 yrs). Ten regularly menstruating women (mean age 28.9 +/- 1.4 yrs) served as controls. Estradiol serum levels as well as lumbar spine bone mineral density were measured. All 11 patients with primary amenorrhea showed osteopenia with a mean bone mineral density Z-score of 71 +/- 2% and mean estradiol levels of 30.6 +/- 5.9 pg/ml. The secondary amenorrheic patients were significantly demineralized with a mean Z-score of 82 +/- 3%; 10 of them had osteopenia. Their mean estradiol levels were 34.3 +/- 2.9 pg/ml. The bone density in the primary amenorrheic patients was significantly lower as compared with the secondary amenorrheic women. In comparison, lumbar spine bone density in all control women was normal with a mean Z-score of 104 +/- 3%. In summary, 21 of the 27 patients had osteopenia, higher than that reported in post-menopausal women. Since it is not proven whether the bone mineral deficit of amenorrheic patients can ever be compensated, early diagnostic steps and estrogen-progestogen replacement for the prevention of further bone loss and subsequent fractures are recommended.

Injectable contraceptive is a contraceptive method with many side effects, hormonal injectables have away of working systemically in the body, causing systemic side effects on the body as well. Based on the results of the BKKBN and PLKB(Field Extension Family Planning) Driyorejo’s village injectables users is quite high compared to other contraceptives. The purpose of this studyw as to determine the old picture with the use of progestin injectables incidence of secondary amenorrhea.The design of this research is descriptive method. The study population was all acceptors progestin’s injection in the hamlet of Karanglo Driyorejo’s village-Gresik of 18 acceptors.The entire population can be the subject of research. Data were collected byi nterview using the interview guidelines.The results of this study indicate that the majority of acceptors progestin injectables using progestin injectables for > 1 year by 80 %. The majority of acceptors progestin injectables contraception experiencing secondary amenorrhea by 75 %. Most of the acceptors were using progestin injectables ≤ 1 year of amenorrhea is not having by 100 %Conclusion research that most acceptors progestin injectables > 1 year experience secondary amenorrhea. It is recommended that the ministry, in particular midwives improve counseling and information to each acceptor progestin injectables especially about the possible side effects so there is no misunderstanding between service providers and service recipients.

The purpose of this study was to evaluate the role of the opioid system and the estrogen environment in the nocturnal secretion of melatonin in women with secondary amenorrhea (SA). Nocturnal melatonin concentrations in patients with SA were significantly higher than in normal women (p0.01 vs. women with normal menstrual cycles). There were significant negative correlations between cumulative melatonin levels (between 8 p.m. and 8 a.m.) and serum estradiol-17 beta (r = -0.561, p0.01) and between peak serum melatonin values and serum estradiol-17 beta concentrations (r = -0.608, p0.01) in SA. Intravenous administration of a conjugated estrogen (Premarin 20 mg) significantly suppressed nocturnal melatonin secretion (p0.05), but a continuous intravenous infusion of naloxone (1.6 mg/h from 8 p.m. to 6 a.m.), an opiate antagonist, did not affect nocturnal melatonin secretion in SA. Our findings suggest that elevated nocturnal melatonin secretion may be related to low estrogen levels, but that it is not mediated by the opioid system.

Secondary amenorrhea in women of reproductive age may be an indication of an undiagnosed, chronic condition and appropriate treatment is dependent upon accurate diagnosis of the underlying etiology. A thorough clinical assessment and a few common laboratory tests can easily identify the most frequent causes of secondary amenorrhea. However, once these have been ruled out, the more uncommon pathophysiologies can be difficult to diagnose due to similarities in presentation and appropriate laboratory testing and interpretation become critical. In these cases, misdiagnosis is unfortunately common and often the result of poor laboratory utilization in the form of a failure to employ indicated tests, the use of obsolete tests, or erroneous interpretation in the face of interfering factors or co-morbidities. Consequently, the algorithmic approach to laboratory evaluation in the context of secondary amenorrhea described in this review can minimize the risk of diagnostic error as well was decrease test volume, cost, and time to diagnosis.

Myasthenia gravis (MG) is an autoimmune disorder characterized by autoantibodies against acetylcholine receptors. MG is generally an isolated disorder but may occur concomitantly with other autoimmune diseases. We describe an eighteen-year-old girl with MG who was admitted to our clinic with secondary amenorrhea and diagnosed as autoimmune oophoritis. Since her myasthenic symptoms did not resolve with anticholinesterase therapy, thymectomy was performed. After thymectomy, her menses have been regular without any hormonal replacement therapy. To our knowledge, this is the first report on a patient with autoimmune ovarian insufficiency and MG in whom premature ovarian insufficiency resolved after thymectomy, without hormonal therapy. Conflict of interest:None declared.

A Chinese adolescent girl presented with secondary amenorrhea. During follow-up, she gradually developed Cushingoid features and virilization. After a series of endocrine investigations, including urinary steroid profiling, a diagnosis of adrenocortical carcinoma was made. The treatment and prognosis of the disease are discussed.

Virilization in an adolescent patient can occur for multiple reasons (ovarian, suprarenal or exogenous reasons). We describe a 14-year-old patient with 1-year secondary amenorrhea, who had an ovarian mature teratoma as a cause of her clinical history.

Pregneninolone may be used for the treatment of oligomenorrhea and secondary amenorrhea in adolescent girls. It is beneficial for some selected patients, particularly those with severe nervousness or dysmenorrhea when advice and observation do not suffice. For the patient who obtains relief from the use of pregneninolone, its administration is believed to be preferable to parenteral endocrine therapy or to large dosage with sedatives or analgesics which may be harmful. This hormone is given to prevent the occurrence of symptoms rather than to relieve those present. The initiation of bleeding has a pyschological advantage. Forty-six girls were treated. Twenty-nine, or 87 per cent, of the thirty-three girls with cycles of three months or less were improved. Pregneninolone is not recommended for those with cycles of longer than six months or for primary amenorrhea, as results were poor in these groups. Although the effect of taking pregneninolone tablets is largely temporary, a follow-up record of thirty patients with improved menstrual cycles showed that twelve, or 40 per cent, continued to menstruate regularly and approximately on time during the six months following completion of treatment.

Pituitary causes of amenorrhea constitute approximately 18% of cases of secondary amenorrhea but only approximately 7% of cases of primary amenorrhea [1]. The most common pituitary cause of amenorrhea is hyperprolactinemia constituting 80% of all pituitary causes of secondary amenorrhea and approximately 15% of cases of secondary amenorrhea due to any cause [2]. In this chapter, we review the causes, clinical presentation, diagnostic evaluation, and current treatment strategies for amenorrhea due to hyperprolactinemia and other pituitary disorders. We present an illustrative case of secondary amenorrhea due to a pituitary cause.

BACKGROUND. The association of secondary amenorrhea with extreme forms of substance use, weight control, and exercise in nonrepresentative samples raises questions as to whether adolescents in the general population who engage in these behaviors are at increased risk for secondary amenorrhea. We examined the prevalence and behavioral correlates of secondary amenorrhea in a county-wide high school population of 2544 girls aged 13 to 18. METHODS. A survey questionnaire, which elicited menstrual history as well as weight history, weight control practices, level of exercise, and use of cigarettes, wine, and beer, was administered during school hours; absentees were also surveyed. The completion rate was 91%. RESULTS. The 1-year prevalence of secondary amenorrhea was 8.5%. Secondary amenorrhea was associated with smoking one or more packs of cigarettes per day (adjusted relative risk [RRa] = 1.96, 1.21-3.10), with multiple binge-eating behaviors in combination with laxative use or self-induced vomiting (RRa = 4.17, 2.54-6.32), and with weight fluctuation due to weight control (RRa = 2.59, 1.33-4.79). There was no association between amenorrhea and alcohol consumption or exercise level. CONCLUSIONS. Estimates of attributable risk are provided and indicate that bulimic behaviors and cigarette smoking may result in a considerable excess of cases of secondary amenorrhea in an adolescent population.

The female distance runner is considered at high risk for secondary amenorrhea and reduced spinal bone mineral, and recent studies have suggested that these disturbances might be nutritionally or metabolically linked. The present study investigated 1) whether there is a physiological basis by which the amenorrheic runner might maintain weight at a lower than expected caloric intake, i.e., conservation of energy, and 2) the potential interactions of reduced energy intake, secondary amenorrhea, and reductions in bone density. Subjects included 13 elite female distance runners, 8 amenorrheic and 5 eumenorrheic, and 5 untrained female controls. Body composition by hydrostatic weighing, bone density and mineral content by dual-photon absorptiometry, and blood samples for hormonal analyses (once per week for 4 wk) were obtained, as were duplicate measures for resting metabolic rate, thermic effect of a meal, and the energy cost of specific (treadmill) and nonspecific (cycle ergometer) physical activity. Energy intake and energy expenditure were estimated by 3-day logs. Energy intakes did not differ (1,781, 1,690, and 1,763 kcal), nor did energy expenditures (2,480, 2,314, and 2,268 kcal), for the amenorrheic and eumenorrheic runner and control groups, respectively. The difference between reported energy intake and estimated energy expenditure of 500–700 kcal was likely due to underreporting or restricting intake, inasmuch as there was no evidence of energy conservation. A possible link was suggested between disordered eating, secondary amenorrhea, and bone mineral loss.

Objective To compare two dosages of oral micronized progesterone (P) and placebo for withdrawal bleeding and side effects. Design Prospective, randomized, double-blind. Setting Academic institution. Participants: Out of 190 screened with oligomenorrhea/amenorrhea, 60 who qualified completed the study. Interventions A 10-day course of (1) oral micronized P 300mg, (2) oral micronized P 200mg, or (3) placebo. Main Outcome Measures Withdrawal bleeding, side effects, and changes in lipids. Endogenous estradiol (E 2 ) concentrations at baseline and P concentrations during treatment were correlated with bleeding response. Results Withdrawal bleeding occurred in 90% of women taking 300mg, 58% of women taking 200mg, and 29% of women taking placebo ( P P =not significant). Lipid concentrations were unchanged. Endogenous E 2 and treatment P concentrations were of limited predictive value for withdrawal bleeding. Conclusions Progesterone 300mg induced significantly more withdrawal bleeding than placebo, with similar side effects. Bleeding response cannot be predicted reliably from E 2 and P concentrations.

WOS: 000259351500011, PubMed ID: 18645253, …

The diagnosis of amenorrhea may be perplexing because of the sheer number of possible causes and the complexity of the structures involved (ie, the CNS-pituitary-ovarian axis). By using the same approach with all amenorrheic patients, rather than classifying them according to primary and secondary amenorrhea, physicians can narrow the diagnostic possibilities quickly and avoid unnecessary and expensive laboratory testing. Referral to a gynecologist or an endocrine specialist is recommended when the workup becomes overly complex.