Absence Of Menstruation Research Articles

Classification of premenstrual disorders as proposed by the International Society for Premenstrual Disorders

Premenstrual disorders have been recognized as affecting innumerable women for decades but unlike most other medical conditions universally accepted criteria for definition and diagnosis are not established. Although premenstrual syndrome (PMS) occurs throughout reproductive life, there are some women who become particularly troubled. Those approaching the menopause may also have a mixture of PMS and menopause symptoms, not to mention heavy periods. Furthermore, some of the symptoms are similar in nature and so it is a challenge to identify which set of symptoms belongs to which spectrum. This is an area that has not been explored well. Various classifications have been proposed over the last few decades. A further effort towards the classification was made by an international multidisciplinary group of experts established as the International Society for Premenstrual Disorders (ISPMD) in Montreal in September 2008. Their deliberations resulted in a unified diagnosis, classification of premenstrual disorders (PMD) along with their quantification and guidelines on clinical trial design. This classification of PMS is far more comprehensive and inclusive than previous attempts. PMD in the ISPMD Montreal consensus are divided into two categories: Core and Variant PMD. Core PMD are typical, pure or reference disorders associated with spontaneous ovulatory menstrual cycles while Variant PMD exist where more complex features are present. Further, the consensus group considered that PMD may be subdivided into three subgroups predominantly physical, predominantly psychological and mixed. Variant PMD encompass primarily four different types; premenstrual exacerbation, PMD with anovulatory ovarian activity, PMD with absent menstruation and progestogen-induced PMD.

Chromosomal abnormalities and hormonal disorders of primary amenorrhea patients in Egypt

BACKGROUND:Primary amenorrhea is defined as the absence of menstruation and secondary sexual characteristics in phenotypic women aged 14 years or older. Hormonal disorders are main causes of primary amenorrhea. Common hormonal cause of primary amenorrhea includes pituitary dysfunction and absent ovarian function. The aim of this study was to estimate the incidence and types of chromosomal abnormalities in patients with primary amenorrhea in Egypt.MATERIALS AND METHODS:Chromosomal analysis and hormonal assay were carried out on 223 patients with primary amenorrhea that were referred from different parts of Egypt to Cytogenetic laboratory of Genetic Unit, Children Hospital Mansoura University, from July 2008 to December 2010. FISH technique was carried out in some of cases to more evaluation.RESULTS:The frequency of chromosomal abnormalities was 46 (20.63%) in primary amenorrhea patients. The chromosomal abnormalities can be classified into four main types. (1) The numerical abnormalities of the X chromosome were detected in 23 (50 %). (2) Structural abnormalities of the X chromosome were detected in 11 (23.91%). (3) Mosaicism of X chromosome was found in 10 (21.74%). (4) Male karyotype 46, XY was presented in 2 (4.35%).CONCLUSION:The present study showed that karyotype and FISH are necessary to detect the causes of primary amenorrhea. This study also revealed the incidence of chromosomal abnormalities in women with primary amenorrhea in Egypt is similar to that reported in previous literatures.

Twice-Weekly Administration of Kisspeptin-54 for 8 Weeks Stimulates Release of Reproductive Hormones in Women With Hypothalamic Amenorrhea

Kisspeptin is a novel therapeutic target for infertility. A single kisspeptin-54 (KP-54) injection acutely stimulates the release of reproductive hormones in women with hypothalamic amenorrhea (HA), a commonly occurring condition characterized by absence of menstruation; however, twice-daily administration of KP-54 results in tachyphylaxis. We determined the time course of desensitization to twice-daily KP-54 injections, compared the effects of twice-daily and twice-weekly administration regimens of KP-54, and studied the effects of long-term twice-weekly administration of KP-54 on the release of reproductive hormones in women with HA. When KP-54 was administered twice daily, responsiveness to luteinizing hormone (LH) diminished gradually, whereas responsiveness to follicle-stimulating hormone (FSH) was nearly abolished by day 2. Twice-weekly KP-54 administration resulted in only partial desensitization, in contrast to the complete tolerance achieved with twice-daily administration. Women with HA who were treated with twice-weekly KP-54 injections had significantly elevated levels of reproductive hormones after 8 weeks as compared with treatment with saline. No adverse effects were observed. This study provides novel pharmacological data on the effects of KP-54 on the release of reproductive hormones in women with HA.

Alleviative Bleeding: Bloodletting, Menstruation and the Politics of Ignorance in a Brazilian Blood Donation Centre

This article focuses on blood donation as a form of bloodletting in a context where donation is commonly seen to alleviate the symptoms of `thick blood'. It deals with the gendered aspects of blood donation, and the parallels drawn between donating blood and menstruating. Women are seen not to need to donate blood as much as men, who, in the absence of menstruation, are more prone to thick blood and require a means to expunge the ensuing excess. While blood donation professionals strive to reconstruct donation as a selfless and ungendered act, counterposing the `facts' of arterial blood circulation to local blood-lore and beliefs, lay understandings challenge this construction in the use they make of blood donation centres or by reiterating the personalistic and gendered dimensions of donation. The article explores cases of patients who use hormonal contraceptives which suppress menstruation and express concerns over the resulting accumulation of blood in the body. It considers how blood donation is adopted by some women as a means of dispelling both the perceived inconveniences of menstrual bleeding and its swelling effects. Such literalized engagements with medical technologies reveal a conception of the body as a permeable, malleable and recipient-like enclosure. These views are often characterized as `ignorance' by medical practitioners, where ignorance is seen to derive not only from the absence of knowledge, but from the presence of the wrong kind of knowledge.

Dietary Approaches and Alternative Therapies for Polycystic Ovary Syndrome

Abstract: Polycystic ovarian syndrome (PCOS) is a common endocrine disorder in reproductive age women. PCOS is characterized by the absence of menstruation or irregular and abnormal menstruation, excessive amounts of body hair, excessive body weight, and infertility. Women with PCOS often have multiple ovarian cysts, high levels of androgen hormones, insulin resistance and metabolic syndrome. This review is focused on the dietary approaches and alternative therapies which have been proved to play major roles in the treatment of PCOS. The ideal diet for PCOS is one that promotes weight loss and then weight maintenance. In addition, some of the essential nutrients may improve associated risk factors of PCOS. Among them are chromium, omega 3 fattyacids, antioxidants, phytosterols, magnesium, calcium, potassium and other essential vitamins and minerals. The most important aspect of treatment is managing cardiovascular risks, such as obesity, high blood cholesterol, diabetes and high blood pressure. Early recognition and aggressive lifestyle interventions are the cornerstones of PCOS treatment. Treating individual risk factors might help to reduce overall risk of PCOS. Some of the PCOS risk factors are modifiable. Aggressive medical nutritional therapy may be appropriate in early conditions than advanced stages.

Presence or Absence of Menstruation in Young Girls

Menstruation is a periodic discharge of sanguinous fluid and sloughing of the uterine lining in the female. It is an event characteristic of the reproductive cycle in humans and most subhuman primates and has no known biological function. However, it is an integral part of a woman's experience throughout her reproductive life. This article will examine menstrual patterns and concerns in young girls. The section on absent menstruation will concentrate on premature ovarian failure.

National Institutes of Health State-of-the-Science Conference Statement: Management of Menopause-Related Symptoms

National Institutes of Health State-of-the-Science Conference Statement: Management of Menopause-Related Symptoms

Bone assessment of female long-distance runners.

The objective of the present study was to investigate the effects of long-distance training on the bones in different growth stages by evaluating the bones of female high school athletes and female adult athletes who engage in long-distance training. Thirteen female high school athletes (aged 15-17 years) and 7 female adult athletes (aged 21-25 years) were enrolled in the present study. Bone mineral density (BMD) and bone mineral content (BMC) were measured using dual X-ray absorptiometry (DXA). Cortical bone status was also evaluated by measuring the tibial speed of sound (t-SOS). The bone metabolic status was evaluated by osteocalcin (OC) and tartrate-resistant acid phosphatase (TRAP). OC ( P < 0.01) and lumbar BMD ( P < 0.05) were significantly higher in high school athletes who were in the modeling period than in the adult athletes. Leg BMD ( P < 0.01) and t-SOS ( P < 0.05) were significantly higher in adult athletes who were in the remodeling period than in high school athletes. When lumbar BMD and leg BMD were compared according to menstrual conditions, the high school athletes with regular menstruation showed a significantly higher level of bone density than those having irregular or absent menstruation. These results indicate that the effect of long-distance training on bone metabolism is influenced strongly by sex hormones during late puberty. We concluded that the effect of long-distance training on bone metabolism in the female high school athletes (i.e., during puberty) was different from that in the adult athletes.

Treatment of Vaginal Atresia at a Missionary Hospital in Bangladesh: Results and Followup of 20 Cases

We report a 9-year experience with successful treatment of patients with vaginal atresia at a missionary hospital with decreased facilities in Bangladesh. From 1995 to 2002, 20 patients 10 to 29 years old (average age 18.4) with Mayer-Rokitansky-Kuster-Hauser syndrome underwent total vaginal replacement. Ten of the 20 females were married and the anomaly was discovered after marriage. In the remaining 10 cases the diagnosis was suspected by the parents because of absent menstruation. In all patients the neovagina was created using a 12 to 14 cm segment of distal sigmoid colon. Short-term morbidity was minimal. At the long-term followup, which was available for 16 patients, the neovagina had a good-appearing introitus. No stenosis, stones or colitis was reported. Six patients already had an active sexual life, which was reported to be satisfactory. Five couples had already adopted 1 or more children. Good perioperative preparation and assistance, assurance of cyclical followup and a trained surgical team permitted successful treatment of a complex genital malformation at a missionary hospital with modest services. Sigmoid vaginoplasty in a developing country seems to be the best choice because of simple management and followup. Young women unable to procreate because of vaginal atresia seem to have an unexpected normal family and social acceptance in Bangladesh after complete vaginal replacement.

Women with polycystic ovarian syndrome had excess hair, irregular or absent menstruation, and infertility and felt freakish, abnormal, and not proper women

Kitzinger C, Willmott J. ‘The thief of womanhood’: women’s experience of polycystic ovarian syndrome. Soc Sci Med2002 ; 54 : 349 –61 [OpenUrl][1][CrossRef][2][PubMed][3][Web of Science][4] QUESTIONS: What are the experiences...

Menopause, climacteric and premature ovarian failure

The menopause represents the cessation of female reproductive potential and is marked by the absence of menstruation. It occurs at an average age of 51 years, which when compared with other non-human primates is unusually early in the lifespan. Oestrogen deficiency results from menopausal ovarian failure and the short- and long-term consequences of this lack affect many organ systems. At the turn of the last century, life expectancy for the average woman in the UK was 48 years. With worldwide increasing life expectancy, now at 68 years (and 80 years at birth in England and Wales), the number of women undergoing the menopause and its consequences in terms of bone, brain, cardiovascular and urogenital ageing is greater than ever before and the personal social and economic consequences of ignoring these demographic changes are immense.

CYCLIC ESTROGEN–PROGESTIN HORMONE THERAPY AS A NEW THERAPEUTIC APPROACH IN THE TREATMENT OF FUNCTIONAL ALTERATIONS OF THE HYPOTHALAMUS-PITUITARY-OVARY AXIS: CASE REPORTS

Amenorrhea is a clinical condition characterized by failure of menarche or by the absence of menstruation for six months in a woman with previous periodic menses. We report a first case of a 30 year-old woman affected by polycystic ovarian disease (PCOD) whose amenorrhea ceased after a 6-month combination treatment with cyclic estradiol–norethisterone acetate. After the withdrawal of the hormone therapy, a stable recovery of periodic menses was observed.We describe a second case of a 23 year-old woman whose amenorrhea was caused by a hypogonadotropic hypogonadism due to a non-functioning pituitary adenoma. After the administration of the previously described therapy both a disappearance of the adenoma and a recover of periodic menses were observed. We hypothesized that the outcomes in our cases could be the consequence of a balancing action induced by the exogenous hormone administration. The exogenous hormones may have reset the feedback between the hypothalamus and pituitary gland through mimicking the physiological hormones pattern of the 28-day cycle.

Length of use and symptoms associated with premature removal of the levonorgestrel intrauterine system: a nation-wide study of 17,360 users.

To establish the continuation rates of the levonorgestrel intrauterine system (LNG IUS) and symptoms associated with its premature removal. All women in Finland who had a LNG IUS inserted between April 1990 and December 1993 and whose doctor had filled in and returned a form at the insertion visit. This study population consists of 46% of all the LNG IUSs sold in Finland between 1990 and 1993. A questionnaire on reproductive and contraceptive history, gynaecological problems and symptoms experienced during the use of the LNG IUS was sent to 23,885 LNG IUS users. A total of 17,914 questionnaires were returned (response rate 75%). The results cover experience from 58,600 woman years. A log-rank-test was used to test differences in continuation rates. Multivariate analyse were performed using Cox's proportional hazard model. The LNG IUS was prematurely removed from 5175 women. The one, two, three, four and five year continuation rates were 93%, 87%, 81%, 75% and 65%, respectively. The symptoms during the use of the LNG IUS most strongly associated with its premature removal were excessive bleeding and spotting, and infections and pain. The risk of premature removal was markedly lower among women who had occasional or total absence of menstruation. Premature removal was less likely in the oldest age group. The continuation rate of the LNG IUS compares favourably with other long-acting contraceptive systems. Totally or occasionally absent menstruation was strongly associated with prolonged continuation.

TREATMENT OF THE MAYER-ROKITANSKY-KUSTER-HAUSER SYNDROME IN BANGLADESH: RESULTS OF 10 TOTAL VAGINAL REPLACEMENTS WITH SIGMOID COLON AT A MISSIONARY HOSPITAL

Purpose We report our experience with treating the Mayer-Rokitansky-Kuster-Hauser syndrome in a developing country. The operations were performed by a pediatric surgical team at a missionary hospital in Khulna, Bangladesh. Materials and Methods From 1995 to 1998, 10 young women with the Mayer-Rokitansky-Kuster-Hauser syndrome underwent complete vaginal replacement. In 4 patients the abnormality was discovered after marriage at the initial sexual approach and, thus, the husband abandoned 3. In 4 of the 10 cases the diagnosis was suspected because of absent menstruation. A physician made the diagnosis in only 2 cases. Preoperatively abdominal ultrasound in 3 patients showed a hypoplastic uterus in all and a right solitary pelvic kidney in 1. In all 10 women a neovagina was created using a 14 cm. segment of sigmoid colon. Two weeks postoperatively patients were taught to dilate and irrigate the neovagina. Results A minimum of 1 year of followup is available in 7 of the 10 patients. The vagina had a good appearing introitus. Mucous production significantly decreased 3 to 4 months after the operation. Two patients already had an active sexual life. The remaining 3 patients underwent surgery during the last mission and they had no complications 6 months postoperatively. Conclusions Our experience shows the feasibility of treating patients with a severe abnormality in a hospital with basic facilities in one of the poorest countries in the world.

Intrauterine accumulation of F-18 FDG during menstruation.

A 45-year-old woman underwent a whole-body FDG PET study during her menstrual cycle. On PET images, a focal area of increased F-18 FDG accumulation resembling a solitary pelvic tumor was noticed above the urinary bladder. MR imaging confirmed that the focal area was within the uterine cavity. After the PET study, a gynecologic examination including cytology was performed, and it revealed no pathologic lesion in the uterus. Fourteen months later, a second PET study was performed in the absence of menstruation. The PET result was normal. It is considered that during menstruation, high F-18 FDG accumulation can be observed in the uterus, probably due to intrauterine hemorrhage.

Bloody Women: A Discourse Analysis of Amenorrhea as a Symptom of Anorexia Nervosa

Amenorhea, the absence of menstruation, is now considered to be a major diagnostic symptom of anorexia nervosa and has been interpreted as `psychobiological' retreat from adult womanhood. However, such interpretations may be overly simplistic. This article draws on poststructuralist theory to examine the ways in which menstruation and amenorrhea are discursively constituted in relation to constructions of femininity. It is based on interviews with 23 women (21 who had been diagnosed as anorexic and two who were self-diagnosed). Discourse analysis of the interviews indicated that `menstruation' was negatively construed as a signifier of `femininity'. However, it signified a very specific `femininity' that was alien, out of control, highly emotional, sexual, vulnerable and dangerous. It is argued that amenorrhea in anorexia may signify a rejection of this particular negative construction of femininity' rather than of adulthood or femininity per se.

Gonadotropin secretion in bulimia nervosa.

Twenty-two normal weight women with bulimia nervosa (BN) were studied (mean age, 25 +/- 5 yr; body mass index, 20.2 +/- 2.6 kg/m2). Sixteen of them reported menstrual cycles in the range of 21-42 days, and 6 had experienced absence of menstruation for at least 3 months. Twenty-one healthy women with regular menstrual cycles (mean age, 23 +/- 2 yr; body mass index, 20.7 +/- 1.4) served as the control subjects. Frequent morning blood samples for estradiol (E2) and progesterone (P4) determinations were obtained for the duration of 1 menstrual cycle or for 6 weeks in the case of amenorrhea. LH, FSH, cortisol, and insulin secretion were studied on day 3, 4, or 5 after the onset of a menstrual cycle or on a random day in the 6 BN women with amenorrhea. Blood samples were collected at 15-min intervals from 1800-0600 h for LH and FSH and at 30-min intervals from 2400-0600 h for cortisol and insulin. Nineteen of the 21 controls, but only 10 of the 22 BN women, fulfilled the following standard criteria: maximum E2 above 440 pmol/L, maximum P4 above 19 nmol/L, and luteal phase length of 9 days or more. The 10 BN women with normal menstrual cycles had lower mean insulin concentrations than the controls (70 +/- 20 vs. 120 +/- 30 pmol/L; P less than 0.01), but gonadotropin secretion, cortisol, and T3 concentrations were similar. The 8 BN women with amenorrhea or ovulatory dysfunction (maximum E2, less than 440 pmol/L; maximum P4, less than 6 nmol/L) displayed decreased mean LH pulse frequency (2.6 +/- 2.4 vs. 5.7 +/- 2.0 pulses/12 h; P less than 0.01), increased mean cortisol (120 +/- 40 vs. 80 +/- 20 nmol/L; P less than 0.01), decreased mean insulin (90 +/- 40 vs. 120 +/- 30 pmol/L; P less than 0.05), and decreased mean T3 concentrations (1.5 +/- 0.3 vs. 1.8 +/- 0.2 nmol/L; P less than 0.01). The data suggest that BN in normal weight women is associated with an increased rate of ovarian dysfunction; decreased pulsatile LH secretion seems to be an important mechanism. Increased cortisol in the disturbed subgroup indicates that activation of the hypothalamic-pituitary-adrenal axis may play a role in the pathogenesis of gonadal dysfunction in bulimia nervosa.

Psychological and physical determinants of premenstrual symptoms before and after hysterectomy

The aim was to study women before and after hysterectomy (with conservation of the ovaries), in order to discover how far premenstrual symptoms are caused physically and how far psychologically. In such women both physical and psychological factors can influence premenstrual symptoms before hysterectomy; after the operation, in the absence of menstruation, only physical factors can do so. The subjects were 56 women awaiting hysterectomy for menorrhagia of benign origin. During three pre-operative months these women made daily self-ratings on a check-list in which typical premenstrual symptoms were interspersed with atypical symptoms; in this way their awareness of the premenstrual focus was minimized. Starting six months after hysterectomy, the women again kept daily check-lists for three months; over the same period their serum progesterone levels were measured to identify the premenstruum. After hysterectomy, levels of premenstrual symptoms fell significantly in the whole group, indicating that psychological factors were important determinants of such symptoms before hysterectomy.

The ovarian cycle and control of ovulation

The ovarian cycle of primates is a sequence of events reflecting follicular growth and development, the ovulation of a mature oocyte and the formation of a functional corpus luteum. A typical cycle generally consists of three phases: (1) the follicular or proliferative phase, (2) ovulation and (3) the luteal or secretory phase. Within this general pattern exists considerable species variation in terms of cycle length, timing of ovulation, presence or absence of menstruation and influence of season.Details of the basic physiological mechanisms controlling cyclic ovarian function in primates are known for only a few species. Concentrating on information derived from studies in women and in rhesus and marmoset monkeys, this paper examines some of the hormonal mechanisms underlying the primate ovarian cycle with particular reference to the factors controlling preovulatory follicular development during the follicular phase.

Use of transrectal radial scan ultrasonography in evaluating the extent of uterine cervical cancer.

Transrectal radial scan ultrasonography has been performed in 180 cases of stage Ib, IIa, or IIb uterine cervical cancer. Increases in the parametrial length, width, their product, and internal echo intensity as well as shift of the cervix to the side of more severe induration have been demonstrated, irrespective of the presence or absence of menstruation, as the clinical infiltration becomes more severe. Furthermore, concerning the presence or absence of histologic infiltration, there is a very strong possibility of a cancerous infiltration in cases of mass formation in the parametrium.