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Aim. To determine genealogical and cytogenetic features in girls aged 12-17 years with secondary amenorrhea. Methods. The analysis of pedigrees was conducted in 25 families of girls with secondary amenorrhea (main group) and in 25 families of healthy girls in the laboratory of medical genetics of SI "ICAHC NAMS". Cytogenetic analysis was carried out in the blood lymphocytes of the girls of the main and control groups in vitro. The control group consisted of 25 healthy peer girls with a regular menstrual cycle without somatic pathology. The data obtained were analyzed statistically using the Student's t-test in Excel programs. Results. The hereditary burden on non-inflammatory (hormone-dependent) gynecological diseases was found in 60.0% of families, in 86.6% of cases – along the maternal line, in 6.7% – along the paternal line, in 6.7% – on both lines at the same time; 40.0% of girls had no hereditary burden. The total incidence of gynecological (non-inflammatory) diseases among relatives of three degrees of kinship was 13.6%, which was almost three times higher than the frequency in relatives of healthy girls (5.1%, p < 0.001). Cytogenetic analysis conducted in girls of the main group showed an increase in both the overall level of chromosomal disorders (6.2%), and their individual types (3.2%. 3.0%, 1.56%) compared to the frequency in healthy girls. Conclusions. Family accumulation of gynecological (non-inflammatory) diseases in the pedigree of girls with secondary amenorrhea has been established. Cytogenetic features in the blood lymphocytes of sick girls are revealed compared to healthy peers. Keywords: girls, pedigrees, cytogenetic indices, secondary amenorrhea.

espanolEl fallo ovarico prematuro (FOP) es un defecto ovarico primario caracterizado por la ausencia de menarquia (amenorrea primaria) o agotamiento prematuro de los foliculos ovaricos antes de los 40 anos (amenorrea secundaria). Como en el caso de menopausia fisiologica, FOP se presenta por manifestaciones tipicas del climaterio: infertilidad asociado con palpitaciones, intolerancia al calor, sofocos, ansiedad, depresion, fatiga. Esta condicion es bioquimicamente caracterizada por niveles bajos de hormonas gonadales (estrogenos e inhibinas) y altos niveles de gonadotropinas (LH y FSH) (amenorrea hipergonadotropica). Mas alla de la infertilidad, los defectos hormonales pueden causar graves consecuencias neurologicas, metabolicas o cardiovasculares y conducir a la aparicion temprana de osteoporosis. La heterogeneidad de FOP tambien se refleja en la variedad de posibles causas, que incluyen autoinmunidad, farmacos toxicos y defectos geneticos. Esta afeccion tiene un fuerte componente genetico. Las anomalias del cromosoma X (por ejemplo, el sindrome de Turner) representan las principales causa de amenorrea primaria asociada con disgenesia ovarica. A pesar de la descripcion de varios genes candidatos, la causa de FOP permanece indeterminada en la gran mayoria de los casos. El manejo incluye la sustitucion del defecto hormonal por preparaciones de estrogeno / progestina. El La unica solucion actualmente disponible para el defecto de fertilidad en mujeres con reserva folicular ausente es donacion de ovulos. EnglishPremature ovarian failure (PFO) is a primary ovarian defect characterized by the absence of menarche (primary amenorrhea) or premature depletion of the ovarian follicles before age 40 (secondary amenorrhea). As in the case of physiological menopause, FOP is presented by typical manifestations of the climacteric: infertility associated with palpitations, intolerance to heat, hot flashes, anxiety, depression, fatigue. This condition is biochemically characterized by low levels of gonadal hormones (estrogens and inhibins) and high levels of gonadotropins (LH and FSH) (hypergonadotropic amenorrhea). Beyond infertility, hormonal defects can cause serious neurological, metabolic or cardiovascular consequences and lead to the early onset of osteoporosis. The heterogeneity of FOP is also reflected in the variety of possible causes, including autoimmunity, toxic drugs, and genetic defects. This condition has a strong genetic component. X chromosome abnormalities (eg, Turner syndrome) represent the leading cause of primary amenorrhea associated with ovarian dysgenesis. Despite the description of several candidate genes, the cause of FOP remains undetermined in the vast majority of cases. Management includes replacement of the hormonal defect with estrogen / progestin preparations. The only solution currently available for the fertility defect in women with absent follicular reserve is egg donation.

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.

The abnormal menstrual flow indicates heavy menses and scanty menstrual flow, both in amount and duration with associated symptom of pain in lower abdomen or back or vagina and can be counted as Vataja Rajodushti, Kshinartava and Artavakshaya in Ayurveda classics. Aims and objectives: In Ayurvedic classic, Uttarabasti is indicated in Yonivyapada (gynecological problems), Artava nasha (secondary amenorrhea), Artava Dosha (menstrual disorder) etc. Vatadosha is the prime cause of Yoni vyapada. Uttara basti has Vatashamak as well as Ropana and Shodhana property. Sahacharadi taila is indicated in Vata disorders including oligomenorrhea. Shatapushpa (Anethum sowa Kurz.) Churna is Arthavajanan. Materials and methods: From OPD 30 patients were selected randomly and divided into 15 patients in each Group A and Group B. Group A was given Shatapushpa churna orally 3times per day for 3 months and Sahacharadi taila Uttaravasti for 3 consecutive cycles. Group B was given placebo. Results were analysed by statistical analysis. Results and conclusion: Properties of Shatapushpa churna, Saacharadi taila with Uttarbasti might improve menstrual irregularities and bring down to normalcy.

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

We present a rare case of a pituitary tuberculoma masquerading as pituitary adenoma with pituitary apoplexy-like presentation in a 31-year-old female, who had symptoms suggestive of acute secondary adrenal insufficiency with secondary amenorrhea. After initial evaluation which was suggestive of pituitary adenoma, she underwent endoscopic transnasal pituitary tumor excision. Histopathology revealed features of pituitary tuberculoma. She was subsequently started on four drug anti-tubercular therapy and is on follow-up. Although uncommon, tuberculomas, especially in the pituitary gland, are known for behaving like pituitary adenomas, by impairment of pituitary hormonal function and by exerting pressure effects on surrounding vital intracranial structures. Diagnostic challenges, treatment modality, and literature review are presented in this case report. Pituitary tuberculoma even though a rare entity should be borne in mind as a differential diagnosis in a patient manifesting with pituitary apoplexy-like syndrome.

Perforated transverse vaginal septum (TVS) leading to secondary amenorrhea in unmarried girl is a rare entity. A 20 years old unmarried girl presented to gynaecology OPD with history of amenorrhea since one month and 12 days, pain lower abdomen with swelling since 7 days and difficulty in voiding urine since 2 days. She had history of regular menstrual cycles since the age of 13 years. Local examination revealed pinkish mass bulging through introitus. MRI showed vaginal outlet obstruction with haematocolpos and haematometra. Diagnosis was confirmed and case was successfully managed during examination under anaesthesia. This case highlights the evolution from perforated transverse low vaginal septum with normal and regular menstrual cycles to a complete septum (due to retained menstrual blood and tissue debris) which leads to secondary amenorrhea.

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.

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.

Intrauterine adhesions have been recognized as a cause of secondary amenorrhea since the end of the nineteenth century [1].

Pituitary insufficiency is an uncommon disorder. The most common cause is compression due to a pituitary mass. Other causes include inflammatory damage and vascular injury like postpartum pituitary apoplexy. Postpartum pituitary apoplexy, also known as Sheehan’s syndrome, leads to hormonal deficiencies and causes postpartum amenorrhea, lactational failure, chronic hyponatremia, hypoglycemia, and loss of secondary sexual characters. Here we are discussing the clinical course of 15 female patients of panhypopituitarism. Most of them had a history of postpartum hemorrhage. Knowledge about this entity is essential as it is a treatable condition and ignorance could prove to be fatal. How to cite this article Bhushan D, Agarwal M, Shukla RK. Hypopituitarism: A Rare but Often Neglected Condition. Indian J Crit Care Med 2020;24(5):350–352.

Secondary amenorrhea, defined as at least 3 months without a period, can be attributed to disruption of the normal hypothalamic–pituitary–gonadal axis. This teaching script provides a clear and systematic approach to evaluating women with secondary amenorrhea with a focus on developing the differential diagnosis and rational diagnostic testing algorithm.

Adrenal myelolipoma with hyperandrogenemia is extremely rare. We report a case of a 26-year-old Chinese female with schizophrenia, who presented with a hormonally active tumor causing hyperandrogenemia. The mass was found by computerized tomography when she had her gynecologic examination for secondary amenorrhea, and it was confirmed to be an adrenal myelolipoma after a histopathological study. She was referred for a left adrenal laparoscopic excision, and the size of adrenal myelolipoma was found to be more than 10 cm. We report this case because large adrenal myelolipomas with hyperandrogenemia and schizophrenia are rare, and adrenal myelolipoma associated with hyperandrogenemia might be determined by the enzymes involved in the production of hormones.

A pituitary abscess is a rare intrasellar infection. Correct identification can be challenging preoperatively given its non-specific symptoms and imaging findings. We report a case of a young woman presenting with secondary amenorrhea, visual field deficits and a 2.6 cm pituitary lesion diagnosed to be a craniopharyngioma. A concomitant unexpected pituitary abscess was diagnosed intraoperatively without associated meningeal symptoms.

Precocious puberty may be gonadotropin dependent or gonadotropin independent and due to a myriad of causes including syndromic association. McCune-Albright syndrome (MAS) is a rare disorder, characterized by the triad of precocious puberty, polyostotic fibrous dysplasia of bone and café-au-lait macules. Here, we describe a case of childhood onset gonadotropin independent precocious puberty who presented at 19 years of age with secondary amenorrhea. On detailed evaluation, she was found to have multiple café au lait spots and polyostotic fibrous dysplasia and diagnosis of MAS were made. Typically, the lesions of fibrous dysplasia are most active during childhood and adolescence, tending to become quiescent in adult life, new active lesions being rare in adults. In our case, despite fibrous dysplasia being asymptomatic on presentation, there were multiple active polyostotic lesions with bilateral encroachment of optic foramina, which is rare at this age. This case highlights the fact that careful examination for syndromic features and periodic follow up are important in all cases of precocious puberty.

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.

Hyperprolactinemia is a frequent condition in clinical practice, responsible for 20–25% of secondary amenorrhea cases. We performed an electronic survey among members of the Brazilian Society of Metabolism and Endocrinology (SBEM) and the Brazilian Federation of Association of Gynecology and Obstetrics (FEBRASGO) to assess diagnostic and therapeutic preferences for management of hyperprolactinemia. Electronic addresses of SBEM and FEBRASGO members were obtained from the directories of these societies, and these members were invited, through electronic messages (e-mail), to answer an online questionnaire that included 10 questions about the treatment of micro and macroprolactinomas, maximum dose of dopamine agonist, how to exclude primary hypothyroidism and macroprolactinemia, hyperprolactinemia and pregnancy. We received responses to the questionnaire by e-mail from 521 SBEM members and 233 FEBRASGO members. The results of this survey demonstrate that there are many area of agreement between SBEM and FEBRASGO members and most of their responses follow the latest Endocrine Society Guideline. Relative to a survey performed several years ago, our findings show that SBEM members have incorporated some of latest recommendations in this field. The principal issues of concern for both groups are duration of dopamine agonist treatment for patients with microprolactinoma and dopamine agonist withdrawal during pregnancy.

Blepharophimosis ptosis epicanthus inversus (BPES) is a relatively rare congenital disorder, which usually presents with classical eye manifestations. In some cases, it is associated with premature ovarian failure (POF). BPES is of two types, type I and type II. Type I is associated with POF along with eyelid malformations, while Type 2 has only eyelid malformations. Here, we report a family of BPES, in whom two sisters presented with secondary amenorrhea. On eye examination, they have blepharophimosis, ptosis, epicanthus inversus and telecanthus. Investigations revealed hypergonadotropic hypogonadism. Their father also has similar eye manifestations. Diagnosis of BPES type I was made and both were started on hormone replacement therapy. To make timely diagnosis of BPES, every patient with POF should specifically be checked for eye manifestations.

The most common cause of primary amenorrhea is congenital malformation of the Müllerian ducts, including Müllerian agenesis, also known as Mayer–Rokitansky–Küster–Hauser syndrome (MRKH). Most general gynecologists and primary care physicians who see female adolescents will encounter MRKH in their careers. We present the case of an adolescent with MRKH who reported secondary, instead of primary amenorrhea. We discuss the subtleties of diagnosing MRKH, especially when patient history may not always be accurate. Because MRKH had not been included in the differential diagnosis for delayed menses, this patient was initially misdiagnosed. Delayed diagnosis of MRKH may harm patients by delaying assessment of concomitant renal, skeletal, hearing, and cardiac defects, which might otherwise impact the treatment plan.

Introduction Sarcoidosis is a granulomatous disease that can affect multiple organ systems including the central nervous system in 5-15% of patients, yet it is a rare cause of intrasellar lesions (

Objectives: To specify the diagnostic difficulties and the criteria allowing a conservative load taking. Observation: We report a case of abdominal pregnancy with live fetus diagnosed ultrasonically at 23WA in a context of abdominal urgency on the background of secondary amenorrhea with prospective follow-up and birth at 36WA. Ultrasound is essential to diagnosis. The treatment is always surgical and the difficulty is dominated by the removal of the placenta. The fetal prognosis is reserved and the maternal mortality is not negligible. Conclusion: Abdominal pregnancy is a rare event. Her diagnosis is difficult and a conservative attitude of pregnancy is possible.

A 23-year-old African American female was referred for secondary amenorrhea evaluation. She attained menarche at 12 years and had regular menses. At 18 years, she used OCPs for few months, and used plan B, after which her menses stopped. She had hot flashes and sweating. She was placed on progesterone, but never had withdrawal bleeding. Review of systems was positive for intentional weight loss after her menses stopped, hair loss and nipple discharge. She denied any loss of sensation of smell. She has a PMH of asthma, anxiety and OSA. Family history was not significant for any fertility issues. She smoked cannabis after menses stopped. On physical examination, vitals were stable, BMI of 35 kg/meter2, well-developed secondary sexual characteristics, no thyromegaly, acne or hirsutism. Upon work up, CBC, CMP were normal, Urine pregnancy test was negative, gonadotropins were undetectable (FSH

Compelling body of evidence exists to use bevacizumab, a humanized monoclonal anti-VEGF antibody, in selected paediatric patients with low-grade CNS tumours. Common toxicities of bevacizumab, hypertension, proteinuria, epistaxis, mucosal perforation, decreased wound healing are well reported. However, the effect of bevacizumab on female ovarian function and long-term fertility is still being documented. Current evidence for bevacizumab-associated decline in ovarian function is largely from breast and colon cancer cohorts where exposure to multimodal chemotherapy confounds causative relationships. Fertility counseling and oocyte cryopreservation is currently offered as standard of care to post-pubertal females at high risk of infertility due to high-dose radiation and chemotherapy. Adolescent females with low-grade CNS tumours on bevacizumab represent a unique population which could potentially be at high risk for infertility. We report 2 cases of adolescent girls treated with bevacizumab as a single agent and in combination with vinblastine for NF2-associated vestibular schwannomas and brainstem glioma respectively. Both patients were post-pubertal with established menstrual cycles and normal baseline FSH/LH/oestradiol/AMH values prior to commencement of therapy. They became amenorrhoeic shortly after starting of therapy with levels of FSH/LH/oestradiol suggestive of premature ovarian failure. One patient has remained asymptomatic, whereas the other has developed profound post-menopausal symptoms interfering with quality of life which necessitated commencement of hormone-replacement therapy. Appropriate pretreatment fertility investigation and consultation should be offered to all post-pubertal females starting on bevacizumab. Further research into the long-term effects of gonadal toxicity in both females and males with drugs inhibiting angiogenesis is needed.

The Female Athlete Triad (Triad) is a medical condition of female athletes consisting of three components: low energy availability (EA), menstrual dysfunction (MD), and low bone mineral density (BMD). The prevalence of all three components of the Triad ranges from 1-14%. In last ten years, it has ranged from 1.3% up to 23% with 78% of female athletes having at least one of the three components of the Triad. The aim of this systematic review is to collect and analyze recent studies of the Female Athlete Triad. Based on an analysis of electronic databases and the inclusion criteria set, 20 studies were included in the analysis. The following conclusions are proposed based on their analysis: MD was the most prevalent among endurance athletes with ranges from 35.5% to 60.7%, with the presence of secondary amenorrhea and oligomenorrhea, 30% to 64.0% and 18% to 27.0% and with a very high level of cases with irregular menorrhea, 72.3%. Low/negative EA ranges from 19.8% among non-leanness athletes and up to 77%. The greatest proportion of athletes in moderate- and high-risk categories for expressing the Triad participated in sports that emphasize leanness, including cross-country, gymnastics running, and lacrosse. A recommendation for future research is that they should focus on enhanced monitoring of physically active women, and the prevention of the Triad, stress fractures and osteoporosis.

Background: Progestogen‑only injectable contraceptives (POICs) remain the most popular contraceptive method in Nigeria. Considering how widely used POICs are worldwide, there is little published evidence of their safety and effectiveness. There is also a paucity of research to determine associations between the influence of age and parity and the preferred choice of POICs in women.Aim: This study was to determine the use prevalence and the influence of age and parity on the preferred choice of POIC, and also the reasons for discontinuation among users of POICs at the family planning clinics of OAUTHC, Ile‑Ife.Materials and Methods: A retrospective record of 324 women who chose POICs out of a total of 1,029 clients seen at the family planning units of the hospital was collected for the period between January and December 2015. Information relevant to this study objectives was extracted using a purpose‑designed proforma. Data were analyzed with SPSS version 16, and results were presented as frequencies and percentages. Pearson Chi‑square test was used as test of significance where applicable and a P value < 0.05 was considered statistically significant.Results: The prevalence of POIC during the study period was 31.49%. Depo‑Provera (depot medroxyprogesterone acetate [DMPA]) was the most popular injectable preferred by the women. Age and parity had significant effects on the preferred injectable contraception with P values of 0.032 (CI 0.088‑0.099) and 0.002 (CI 0.009‑0.013), respectively, as younger clients with lower parity preferred Noristerat while preference for DMPA increased with age and parity. Majority (67%) did not experience any side effect; secondary amenorrhea was the most common side effect experienced by 27% of the clients. Only 34% continued with the method for the duration of study while 66% discontinued for different reasons.Conclusion: POICs are very effective and safe long‑acting reversible method of contraception. While DMPA may be the more popular overall choice, norethisterone enanthate (NET‑EN) is preferable in younger women of low parity.Keywords: Depoprovera; Ile-Ife; Noristerat

Unlike many conditions in medicine, the classification of painful menstruation into primary and secondary dysmenorrhea is not based on the temporal appearance of symptoms or the condition, as it is in primary and secondary amenorrhea, or primary and secondary infertility. The taxonomy of primary and secondary dysmenorrhea is based upon the absence or presence (respectively) of clinically identifiable causes. In both cases, a great deal is known about the pathophysiology underlying the development of menstrual pain. It is, therefore, not an issue of a lack of identifiable causation; it is the lack of clinically identifiable processes that drive the assignment.

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.

The “resistant ovary syndrome” or “Savage syndrome” is a rare cause of hypergonadotropic hypogonadism, in which the ovaries are resistant to follicle-stimulating hormone (FSH), leading to a primary or secondary amenorrhea with high gonadotropin levels (FSH and Luteinizing hormone (LH)) despite a normal ovarian follicle pool.

Since the activity of the reproductive axis is quite complex and modulated and/or affected by several neurotransmitters, neuromodulators and hormones, it is easy to understand that minimal changes of the equilibrium of few of these substances might induce changes of the reproductive axis leading to the amenorrheic condition.