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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

Objective: To determine the status of thyroid system in girls with secondary amenorrhea (SA).Patients and methods. The study included 82 girls in the age 14-17 years with SA (main group). The control group consisted of 78 girls of the same age with a normal volume of the thyroid gland (TG), harmonious physical development and normal menstrual function. Ultrasound examination and examination of the thyroid gland state are included in the study.Results. The results of visual palpation and ultrasound examination of the thyroid gland state revealed the presence of thyropathies in more than half of patients with SA: diffuse nontoxic goiter of 1-2 (9.8%), autoimmune thyroiditis (12.2%), nodular goiter (3.6%) and thyroid hypoplasia (17.1%).Conclusions a significant number of girls with SA have thyroid dysfunction due to various changes in TTH and free fractions of thyroid hormones independently on the presence of the thyroid pathology.Key words: girls, thyroid gland, thyroid status, secondary amenorrhea., Цель: определить состояние тиреоидной системы у девушек с вторичной аменореей (ВА).Пациенты и методы. Под наблюдением находились 82 девушки в возрасте 14–17 лет с ВА (основная группа). Контрольную группу составили 78 девушек-ровесниц с нормальным объемом щитовидной железы (ЩЗ), гармоничным физическим развитием и нормальной менструальной функцией. Изучались особенности ультразвуковой картины ЩЗ и тиреоидного статуса.Результаты. По результатам визуально-пальпаторного и ультразвукового исследования состояния ЩЗ установлено наличие тиреопатий почти у половины больных ВА: ДНЗ 1–2 ст. (9,8%), АИТ (12,2%), узловой зоб (3,6%), гипоплазия ЩЗ (17,1%).Выводы. У значительного количества девушек с ВА, независимо от наличия тиреидной патологии, происходит формирование тиреоидной дисфункции за счет разнонаправленных изменений в показателях ТТГ и свободных фракций тиреоидных гормонов.Ключевые слова: девушки-подростки, щитовидная железа, тиреоидный статус, вторичная аменорея., Мета: визначити стан тиреоїдної системи у дівчат із вторинною аменореєю (ВА).Пацієнти і методи. Під спостереженням знаходилось 82 дівчат віком 14–17 років із ВА (основна група). Контрольну групу склали 78 дівчат-однолітків із нормальним об'ємом щитоподібної залози (ЩЗ), гармонійним фізичним розвитком та нормальною менструальною функцією. Вивчалися особливості ультразвукової картини ЩЗ і тиреоїдного статусу.Результати. За результатами візуально-пальпаторного та ультразвукового дослідження стану ЩЗ встановлено наявність тиреопатій майже у половини хворих на ВА: ДНЗ 1–2 ст. (9,8%), АІТ (12,2%), вузловий зоб (3,6%), гіпоплазію ЩЗ (17,1%).Висновки. У значної кількості дівчат із ВА, незалежно від наявності тиреоїдної патології, відбувається формування тиреоїдної дисфункції за рахунок різноспрямованих змін у показниках ТТГ та вільних фракцій тиреоїдних гормонів.Ключові слова: дівчата-підлітки, щитоподібна залоза, тиреоїдний статус, вторинна аменорея.

Мета роботи — з’ясувати зв’язки між клінічними симптомами і рівнем статевих гормонів у крові при вторинній аменореї (ВА) у дівчат­підлітків.Матеріали та методи. Проведено клінічне та гормональне (естрадіол (Е2), тестостерон (Т), прогестерон (ПГ)) обстеження 147 13—17­річних пацієнток із ВА і 68 дівчат із регулярним менструальним циклом (група порівняння). Враховували характер менструальної функції (МФ) до виникнення ВА, частоту раннього і пізнього менархе, тривалість затримки менструації, наявність гірсутизму, розміри матки і зміну структури яєчників за даними УЗД органів малого таза, типи кольпоцитограм (КЦГ), індекс маси тіла (ІМТ), бал розвитку вторинних статевих ознак (БРВСО).Результати та обговорення. У пацієнток із ВА виявлено закономірні зв’язки Е2 і Т з ІМТ, БРВСО, характером МФ до виникнення ВА. Встановлено зв’язок Е2 і ПГ із тривалістю ВА, а Т — із наявністю гірсутизму. У той же час у хворих із ВА були відсутні зв’язки статевих гормонів з розмірами матки і структурою яєчників, типом КЦГ, віком менархе.Висновки. У дівчат­підлітків із ВА зберігаються зв’язки статевих гормонів з такими клінічними ознаками, як ІМТ, БРВСО, характер МФ до виникнення ВА, тривалість ВА, наявність гірсутизму. Дані про невідповідність типу КЦГ, розмірів матки й рівня Е2 в сироватці крові можуть свідчити про порушення рецептивності матки до Е2 як одну з ланок патогенезу ВА в період пубертату., The aim is to clarify relationships between clinical symptoms and the blood level of sex hormones in adolescent girls with secondary amenorrhea (SA).Materials and methods. A clinical and hormonal investigation (estradiol-E2, testosterone — T, progesterone — PG) in 147 patients with SA aged 13—17 years, and 68 girls with regular menstrual cycles (control group) was done. The author intended to identify: the nature of menstrual function (MF) before SA onset, the frequency of early and late menarche, duration of menstruation delay, presence of hirsutism, uterine size and changes in the structure of ovaries according to the ultrasound data of the pelvic organs, colpocytogram types (CCGT), body mass index (BMI), the score of secondary sex characteristics (SSSC).Results and discussion. In patients with SA have been revealed the relationships between E2 and T with BMI, SSSC and MF nature before SA onset. Moreover, it has been established the relationship between PG and E2 with the duration of SA, and between T with the presence of hirsutism. At the same time, in patients with SA no relations have been registered between sex hormones with uterus size, ovaries structure, CCGT, and the age of menarche.Conclusions. In adolescent girls with SA saved relationships of sex hormones with such clinical parameters as BMI, SSSC, and MF nature before SA onset, presence of hirsutism, duration of SA. Data about discrepancy of CCGT type, uterine size and level of E2 in serum may indicate the disorder of uterus receptivity to E2 as one of the pathogenesis element of SA during puberty., Цель работы — выяснить связь между клиническими симптомами и уровнем половых гормонов в крови при вторичной аменорее (ВА) у девочек­подростков.Материалы и методы. Проведено клиническое и гормональное (эстрадиол (Э2), тестостерон (Т), прогестерон (ПГ)) обследование 147 13—17­летних пациенток с ВА и 68 девочек с регулярным менструальным циклом (группа сравнения). Учитывали характер менструальной функции (МФ) до возникновения ВА, частоту раннего и позднего менархе, продол­­жительность задержки менструации, наличие гирсутизма, размеры матки и изменение структуры яичников по данным УЗИ органов малого таза, типы кольпоцитограмм (КЦГ), индекс массы тела (ИМТ), балл развития вторичных половых признаков (БРВПП).Результаты и обсуждение. У пациенток с ВА выявлены закономерные связи Э2 и Т с ИМТ, БРВПП, характером МФ до возникновения ВА. Установлена связь Э2 и ПГ с длительностью ВА, а Т — с наличием гирсутизма. В то же время у больных с ВА отсутствовали связи половых гормонов с размерами матки и структурой яичников, типом КЦГ, возрастом менархе.Выводы. У девочек­подростков с ВА сохраняются связи половых гормонов с такими клиническими признаками, как ИМТ, БРВПП, характер МФ до возникновения ВА, длительность ВА, наличие гирсутизма. Данные о несоответствии типа КЦГ, размеров матки и уровня Э2 в сыворотке крови могут свидетельствовать о нарушении рецептивности матки к Э2 как одном из звеньев патогенеза ВА в период пубертата.

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.

A 26-year-old woman with secondary amenorrhea and turneroid stigmata was found to have a 46,X,rea(X)(qter→p11.2::q21.2→qter)/46,X,del(X)(qter→p11.2:) mosaicism in 101 G-banded metaphases (71 and 30, respectively). The mother's karyotype was normal (the father was already deceased). A fully skewed inactivation of both abnormal X-chromosomes was documented in RBG-banded metaphases and by means of the HUMARA assay. In addition, the latter revealed that the involved X-chromosome was the paternal one. The patient's secondary amenorrhea and turneroid stigmata can reliably be ascribed to her nearly complete Xp deletion present in all cells. Thus, this observation is consistent with the well-known gradation of ovarian function depending on the Xp deletion size. We assume that the first event was an intrachromosome recombination during paternal meiosis between paralogous sequences at Xp11.2 and Xq21.2, which resulted in a fertilizing rea(X) spermatozoid. Early in embryogenesis, the rea(X) dissociated at the Xp11.2 junction point to originate the del(X), which in turn was healed by the de novo addition of telomeric repeats (the acentric Xq21.2→qter segment was lost in the process). The reverse sequence appears unlikely because it implies that the del(X) chromosome was healed only after it undergone a postzygotic interchromatid recombination and apposite segregation required to obtain the rea(X) clone. The present observation further expands the cytogenetic heterogeneity in Turner syndrome and may represent another instance of a terminal deletion healed by the de novo addition of telomeric repeats.

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.

Premature ovarian failure (POF) is a complex disorder that affects approximately 1% of women. POF is characterized by the depletion of functional ovarian follicles before the age of 40 years, and clinically, patients may present with primary amenorrhea or secondary amenorrhea. Although some genes have been hypothesized to be candidates responsible for POF, the etiology of most of the cases is idiopathic, with the underlying causes still unidentified because of the heterogeneity of the disease. In this review, we consider some mutant mouse models that exhibit phenotypes which are comparable to human POF, and we suggest that the use of these mouse models may help us to gain a better understanding of the molecular mechanisms underlying POF in humans.

Eine sekundare Amenorrho kann in seltenen Fallen durch einen endokrinen Tumor ausgelost werden. Dieser Befund erfordert eine enge interdisziplinare Zusammenarbeit zwischen Endokrinologie, Onkologie, Radiologie, Chirurgie und eine referenzpathologische Begutachtung des Tumormaterials. Patienten mit ovariellen Keimstrangstromatumoren sollten gemas der MAKEI-Therapieoptimierungsstudie der GPOH registriert und behandelt werden.

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.

Polycystic ovarian syndrome (PCOS) is the most common endocrine disease of women of reproductive age, yet it remains undiagnosed for many women. The reason the syndrome is often not diagnosed or is misdiagnosed is because PCOS can present with a variety of abnormalities that can be present in other endocrine dysfunctions and problems. Concerns about abnormal menses, an inability to conceive, or cosmetic problems often are what bring these women into the clinical setting. The disease is the result of a defect in the hypothalamic-pituitary-ovarian circuit, but the cause is unknown. With appropriate diagnosis and management, the patient may delay or prevent negative physical and psychological consequences brought on by this syndrome.

Фолликулостимулирующий гормон играет значительную роль в фолликулогенезе, связываясь со своими рецепторами, расположенными на поверхности клеток гранулезы.Молекулярные эффекты мутации рецептора фолликулостимулирующего гормона следующие: при варианте аллеля 680Ser активность рецепторов фолликулостимулирующего гормона снижена, вследствие чего у женщин зачастую наблюдается сниженный уровень эстрадиола, прогестерона и ингибина А в крови, ранний рост и повышенный уровень фолликулостимулирующего гормона в лютеиновой фазе менструального цикла. Полиморфизм данного гена определяет ответ на стимуляцию яичников препаратами фолликулостимулирующего гормона. При варианте аллеля 680Ser у женщин зачастую наблюдается удлинение менструального цикла за счет увеличения периода от лютеолиза до овуляции, что в свою очередь может ухудшать ответ на стимуляцию яичников препаратами фолликулостимулирующего гормона для экстракорпорального оплодотворения, а также усугублять проявления синдрома гиперстимуляции яичников.В данной статье представлен клинический случай успешного завершения беременности и родов после контролируемой овариальной стимуляции у пациентки 27 лет с мутацией гена рецептора фолликулостимулирующего гормона, вторичной аменореей, гипоплазией матки, нарушенной рецептивностью эндометрия.В приведенном клиническом случае описаны особенности циклов вспомогательных репродуктивных технологий у пациентки со вторичной аменореей, гипоплазией матки, нарушением рецептивности эндометрия на фоне мутации гена рецептора фолликулостимулирующего гормона, высокого уровня антимюллерова гормона и неэффективного оперативного лечения в анамнезе. Особенности циклов контролируемой овариальной стимуляции в данном случае: низкая стартовая доза гонадотропных препаратов и продолжительность стимуляции (триггер овуляции на 19 и 22 день стимуляции). Мутация гена рецептора фолликулостимулирующего гормона сопровождалась полиморфизмом генов фолатного цикла, свертывающей системы крови, а также снижением рецептивности эндометрия и смещением окна имплантации. Учет вышеизложенных факторов способствовал рождению мальчика весом 3870 г, ростом 52 см.Рассмотренный клинический случай свидетельствует о необходимости индивидуального подхода к ведению пациенток с эндокринными отклонениями., Фолікулостимулюючий гормон відіграє значну роль у фолікулогенезі, зв'язуючись зі своїми рецепторами, розташованими на поверхні клітин гранульози.Молекулярні ефекти мутації рецептора фолікулостимулюючого гормону наступні: при варіанті алеля 680Ser активність рецепторів фолікулостимулюючого гормону знижена, внаслідок чого в жінок найчастіше спостерігається знижений рівень естрадіолу, прогестерону та інгібіну А в крові, ранній ріст і підвищений рівень фолікулостимулюючого гормону в лютеїновій фазі менструального циклу. Поліморфізм даного гена визначає відповідь на стимуляцію яєчників препаратами фолікулостимулюючого гормону. При варіанті алеля 680Ser у жінок найчастіше спостерігається подовження менструального циклу за рахунок збільшення періоду від лютеолізу до овуляції, що в свою чергу може погіршувати відповідь на стимуляцію яєчників препаратами фолікулостимулюючого гормону для екстракорпорального запліднення, а також посилювати прояви синдрому гіперстимуляції яєчників.У даній статті представлений клінічний випадок успішного завершення вагітності та пологів після контрольованої оваріальної стимуляції у пацієнтки 27 років із мутацією гена рецептора фолікулостимулюючого гормону, вторинною аменореєю, гіпоплазією матки, порушеною рецептивністю ендометрія.У наведеному клінічному випадку описані особливості циклів допоміжних репродуктивних технологій у пацієнтки з вторинною аменореєю, гіпоплазією матки, порушенням рецептивності ендометрія на фоні мутації гена рецептора фолікулостимулюючого гормону, високого рівня антимюлерового гормону та неефективного оперативного лікування в анамнезі. Особливості циклів контрольованої оваріальної стимуляції в даному випадку: низька стартова доза гонадотропних препаратів і тривалість стимуляції (тригер овуляції на 19 та 22 день стимуляції). Мутація гена рецептора фолікулостимулюючого гормону супроводжувалася поліморфізмом генів фолатного циклу, системи згортання крові, а також зниженням рецептивності ендометрія та зміщенням вікна імплантації. Врахування вищевикладених чинників сприяло народженню хлопчика вагою 3870 г, зростом 52 см.Розглянутий клінічний випадок свідчить про необхідність індивідуального підходу до ведення пацієнток із ендокринними відхиленнями., Follicle-stimulating hormone (FSH) plays a significant role in folliculogenesis by binding to its receptors located on the surface of the granulosa cells.Molecular effects of FSH receptor mutation are following. FSH receptor activity is reduced at variant 680Ser, often resulting in women decreased levels of estradiol, progesterone, and inhibin A levels, early growth and increased level of FSH in the luteal phase of the menstrual cycle. Polymorphism of this gene determines the response to ovarian stimulation by FSH drugs. In women with variant 680Ser is often lengthening menstrual cycle by increasing the period from luteolysis to ovulation, that is can impair the response to ovarian stimulation with FSH drugs in vitro fertilization, as well as exacerbate the symptoms of ovarian hyperstimulation syndrome.This article described the clinical case of successful completion of the pregnancy and birth after controlled ovarian stimulation in a patient 27 years old with a mutation of the FSH receptor gene, secondary amenorrhea, uterus hypoplasia, impaired endometrial receptivity.In the clinical case described the features of assisted reproductive technology cycles in a patient with secondary amenorrhea, uterus hypoplasia, disorders of endometrial receptivity against the backdrop of the FSH receptor gene mutation, high levels of the anti-Mullerian hormone and ineffective surgery history. Features of controlled ovarian stimulation cycles in this case are a low initial dose of gonadotropin drugs and duration of stimulation (trigger ovulation at the 19 and 22 day of stimulation). Mutation of the FSH gene receptor was accompanied gene polymorphism of folate cycle, blood coagulation, as well as endometrial receptivity decrease and the displacement of implantation window. Taking into account these factors have led to the birth of a boy weighing 3870 g, height 52 cm.This clinical case demonstrates the need for an individual approach to the management of patients with endocrine disorders.

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.

Menstrual disorders are a common problem in young girls. Table 1.1 presents the menstrual disorders during adolescence among 790 cases treated in our institution.

Vesico-uterin fistula is a rare type of fistulas and can be diagnosed frequently after surgery. First described by Youssef in 1957. Clasically findings are; cyclic haematuria without urinary incontinence and secondary amenorrhea. The patient was referred to our clinic for cyclic hematuria and she was diagnosed with vesicouterine fistula by radiological imaging methods and a cystoscopy procedure. Being a rare occurrence, this case was reported with a discussion of the relevant literature.

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.

Transverse vaginal septum is one of the rare mullerian anomaly with recurrent cicatrization of septum being its most common complication. A 29 year old patient with secondary amenorrhea and abdominal mass, was diagnosed as having recurrent cicatrization of transverse vaginal septum. She was operated twice abdominally and many attempts for septum resection with dilatation were carried out vaginally. Resection of the obstructing membrane to lengthen the lower vagina and overlapping vaginal mucosal anastomosis was done.

Pubertal onset and sexual development are usually normal in 47, XXX individuals; however, we report two cases of premature ovarian failure (POF) in infertile women with trisomy X.Chromosome analysis was conducted with G-banding and fluorescence in situ hybridization using X- and Y-bearing probe. Hormonal administration was primarily Kaufmann's treatment or long-term estradiol treatment, followed by withdrawal bleeding from estrogen and progesterone.Two patients with trisomy X, aged 31 (patient 1) and 27 years (patient 2), were diagnosed with POF due to hypergonadotropic hypogonadism. Their ovaries were small. Patient 1 had a FSH level of 44.6 mIU/ml and patient 2 had a FSH level of 74.6 mIU/ml. In patient 1, with Kaufmann's treatment, the FSH decreased to 13.5 mIU/ml; however, follicle growth did not occur following HMG stimulation. In patient 2, FSH did not decrease despite Kaufmann's treatment; therefore, she was given a GnRH agonist and her FSH level decreased to 7.1 mIU/ml. However, her ovaries never responded to HMG stimulation.We report on two patients with a 47, XXX karyotype who became infertile due to POF. We recommend that when a patient is diagnosed with trisomy X, the possibility of POF must be strongly considered.

Triple X syndrome is a sex chromosome abnormality characterized by extra X chromosome, occurring in approximately 1 in 1,000 female births. This condition often remains undiagnosed as most of them have normal phenotype, puberty and fertility. We report a case of Triple X syndrome with normal phenotype and intelligence presented with secondary amenorrhea and diagnosed to have premature ovarian failure. This case emphasizes the need for chromosomal analysis in women presenting with premature ovarian failure leading to primary or secondary amenorrhea.How to cite this articleChandana C, Venkatesh S. Triple X Syndrome Woman Presenting as Premature Ovarian Failure. Int J Infertility Fetal Med 2013;4(3):96-98.

Secondary cryptomenorrhea is a rare disorder and results due to adhesion formation postdelivery and puerperal sepsis. We report such a case who presented as amenorrhea and progressive pain in the abdomen postdelivery. How to cite this article Amrin S, Mukherjee S, Khan S, Jain U. A Case of Secondary Amenorrhea as a Result of Cervical Atresia Postdelivery. Int J Adv Integ Med Sci 2016;1(2):86-87.

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.

Introduction There are currently few studies focusing on the efficacy of long-term atypical antipsychotics to treat anorexia nervosa in the pediatric population. Case description This case report follows the treatment of a 17 year-old female with anorexia nervosa over her four-year undergraduate career. After two years of multidisciplinary treatment, low-dose risperidone was initiated due to persistence of her disease. She expressed decreased rigidity around meal times, her weight improved and she had resumption of menses. She was compliant with treatment through graduation and maintained her weight gain. Discussion & evaluation Atypical antipsychotics are a treatment option in the management of anorexia nervosa. Risperidone has not been studied as frequently as olanzapine for eating disorders. Risperidone was chosen for its more favorable side effect profile and decreased cost to the patient. Previous studies on anorexia nervosa treatment have occurred during inpatient treatment and have limited follow-up due to patients’ refusal to initiate or maintain medication compliance. This case presents 17 months of outpatient data. The efficacy of risperidone therapy was evaluated with frequent weight checks, subjective decrease in rigidity, serial complete metabolic panels, and restoration of menses. Conclusions In this case report, an adolescent female treated with low-dose risperidone had decreased rigid thinking, weight gain and resolution of secondary amenorrhea without medication side effects. Therefore, the atypical antipsychotic risperidone may be an effective long-term outpatient treatment option for patients with anorexia nervosa.

Perinatal histories of 172 adolescent girls aged 13–17 years with secondary amenorrhea (SA) and 102 age-matched girls with regular menstrual cycle (comparison group), and reproductive status of their mothers have been studied. It has been found that the most unfavorable factor affecting the formation of SA in adolescent girls is the late menarche in their mothers. It is found that the probability of SA in girls born from the mothers with late menarche right after menarche or after previous menstrual disorders is 16-fold increased. Ir is determined that particularly unfavorable factor, 3-fold increasing the risk of the transformation of olygomenorrhea or pubertal uterine bleeding into SA, is the low birth weight registered in the patient’s history., Изучен перинатальный анамнез 172 девочек-подростков 13–17 лет со вторичной аменореей (ВА) и 102 девочек того же возраста с регулярным менструальным циклом (группа сравнения) и состояние репродуктивной системы их матерей. Показано, что наиболее неблагоприятным фактором, влияющим на возникновение вторичной аменореи у девочек-подростков, является наличие позднего менархе у матери. Определено, что вероятность возникновения ВА у девочек, рожденных матерями с поздним менархе, сразу после менархе или после предшествующих нарушений менструальной функции увеличивается в 16 раз. Установлено, что особо неблагоприятным фактором, повышающим в три раза вероятность перехода во вторичную аменорею олигоменореи или пубертатного маточного кровотечения, можно считать наличие в анамнезе больной низкой массы тела при рождении., Вивчено перинатальний анамнез 172 дівчат-підлітків 13–17 років із вторинною аменореєю (ВА) і 102 дівчат того ж віку з регулярним менструальним циклом (група порівняння) і стан репродуктивної системи їх матерів. Показано, що найбільш несприятливим фактором, що впливає на виникнення вторинної аменореї в дівчат-підлітків, є наявність пізнього менархе в матері. Визначено, що ймовірність виникнення ВА в дівчаток, народжених матерями з пізнім менархе, відразу після менархе або після попередніх порушень менструальної функції збільшується в 16 разів. Встановлено, що особливо несприятливим чинником, що підвищує в три рази ймовірність переходу у вторинну аменорею олігоменореї або пубертатної маткової кровотечі, можна вважати наявність в анамнезі хворої низької маси тіла при народженні.

Hintergrund: Bei Spontanpneumothoraces bei jungen Menschen ist immer auch an die Langerhans-Zell-Histiozytose (LCH) zu denken. Dies wird mit folgendem Fall belegt. Fallbericht: Eine 20-jahrige Patientin kam wegen eines Pneumothorax ins Krankenhaus. Es bestand eine sekundare Amenorrho. An der Bauchhaut und im Anogenitalbereich zeigte sich ein makulopapuloses Exanthem. Nach Rontgenaufnahme und HR-CT des Thorax ergab sich der Verdacht einer Histiozytosis X, die durch Lungen- und Hautbiopsie gesichert wurde. Die Ursache der Amenorrho war eine Infiltration des Hypophysenstiels im Rahmen der Grunderkrankung. Unter der Therapie mit Vinblastin, gefolgt von Vinblastin mit Prednison, sowie unter Etoposid und Prednison kam es zu rezidivierenden Pneumothoraces beidseitig. Eine veranderte Chemotherapie, entsprechend dem LCH-II-Studienprotokoll fur kinder, fuhrte zu einer kompletten Remission.

大阪教育大学保健管理センター婦人科健康相談に来所した続発性無月経を主訴としたもの12人について,基礎体温の測定,腹部超音波を使用した子宮,卵巣の観察,血中LH,FSH,PRL (prolactin), E2(estradiol)の測定を行った。また体脂肪量をタニタ体内脂肪計TBF-401にて測定した。さらにAloca社製造音波骨評価装置AOS-100にて骨塩量の測定を行った。結果として,基礎体温からはすべて低温一相性であった。また腹部超音波から子宮,卵巣の器質的疾患を認めたものはなかった。血液検査では,第二度無月経でLH, FSHが低値であった。E2が低値の3人は第二度無月経のものが1人,無排卵周期となったものが2人で,またE2が正常値であったものでは無月経期間が8カ月におよぶものでも様子観察のみで月経が再来した。即ちE2は予後と関係した。体重及び体脂肪率に関しては,体重減少による続発性無月経が7人,このうちダイエットによるものが4人,スポーツによるものが3人であった。またBMIに関しては18未満のものが66.7%であった。体重減少例とBMI低値の症例をあわせ,10人が低体重による続発性無月経と考えられた。体脂肪率,BMI共に著しく低値であった1人は第二度無月経の症例であった。超音波による骨評価では,OSI,Z値,T値は2.702±0.042,95±4,97±4と同年代の女子に比し低い傾向にあった。また診断と治療をかねて投与したGestagenによって,6カ月以上続いた続発性無月経の8人中5人で月経が再来し,2人で無排卵周期まで回復した。1人のみが第二度無月経でKaufman療法を必要とした。, Twelve secondary amenorrhea students at Osaka Kyouiku University served as subjects and we measured following parameters; (1) serum LH, FSH, prolactine and estradiol level, (2) ultrasonographical examination of pelvic cavity, (3) body weight, body mass index (BMI), fat volume using the body fat scale (Tanita TBF-40), (4) bone mineral assesment using the ultrasonic bone analyzer (AOS-100). The results as follows: (1) All basal body temperature were only low phase. 8 Students were given oral gestagen. 7 students were appeared withdrawal bleeding, but 1 student was not appeared, so she needed Kaufman therapy. (2) 11 students were done ultrasonographically examinations, and the uterine length of 10 students were shorter than 6 cm. (3) Serun LH level was high in 1 student. Estadiol level were low in 3 students (1 student; the secound grade amenorrhea, 2 students; anovulatury cycle post oral gestagen therapy). So serum estadiol level was related with prognosis of secondary amenorrhea. (4) The cause of amenorrhea of 7 students was decrease in body weight. In relation with body mass index, 66.7 % was under level of 18. (5) In concerning with bone mineral assesment, 10 students were measured. OSI, TI, ZI were 2.702±0.042, 95±4, 97±4.

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.

A 28-year-old Turner female with secondary amenorrhea is described, who showed 45,X/46,X,del(Xp) mosaicism in her blood lymphocytes and a 46,X,del(Xp) karyotype only in her ovaries. 45,X/46,XX mosaicism was found in the patient's mother, who presented short stature, mild Turner dysmorphism and had a normal reproductive life-span. Phenotypic implications of the cytogenetic findings in the patients are discussed, and literature data on fertility in Turner syndrome are briefly reviewed.

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.