Occurrence Of Amenorrhea Research Articles

Relationship between the duration of injectable contraceptive Depo Medroxy Progesterone Acetat (DMPA) With the Occurrence of Amenorrhea in Family Planning Acceptors at the Pratama Delima Rahayu Clinic, Sragen

Amenorrhea is a condition where a person does not experience menstruation for 3 to 6 months in a row. This research aims to analyze the relationship between length of use of injectable contraceptives Depo Medroxy Progesterone Acetat (DMPA) with the occurrence of amenorrhea in family planning acceptors at the Pratama Delima Rahayu Clinic, Sragen Indonesia. This type of analytical survey research uses a cross sectional approach. The sampling technique for this research is to use a total sampling technique, namely the entire population. The results of the research show that the length of use of the Depo Medroxy Progesterone Acetate (DMPA) contraceptive injection has a significant relationship with the occurrence of amenorrhea in contraceptive acceptors at the Pratama Delima Rahayu Sragen Clinic with a probability value of 0.001 < 0.05. The conclusion from this research is that the longer you use DMPA injection contraceptives, the longer you will experience menstrual disorders, one of which is amenorrhea.

Application of TB type thermal balloon endometrial ablation for the treatment of abnormal uterine bleeding

Objective: To investigate the clinical efficacy, safety and promotion value of TB type thermal balloon endometrial ablation in the treatment of abnormal uterine bleeding. Methods: Fourty three patients who had received TB type endometrial ablation system for treatment of abnormal uterine bleeding from January, 2015 to January, 2016 in theDepartment of gynecology, Beijing Chaoyang Hospital were enrolled in this study. The intra-operative and post-operative complications and improvement of abnormal uterine bleeding and dysmenorrhea were observed. Results: There were nointra-operative complication occurred, such as uterine perforation, massive hemorrhage or surrounding organ damage. At 6 months after operation, 32 patients developed amenorrhea, 6 developed menstrual spotting, 3 developed menstruation with a small volume and 1 had a normal menstruation. No menstruation with an increased volume occurred. The occurrence of amenorrhea was 76.19% and the response rate was 97.62%.At 6 months after operation, 1 case had no response, 2 cases had partial response and 11 cases had complete response among the 14 cases of pre-operative dysmenorrhea; only 3 cases still had anemia among the 23 cases of pre-operative anemia. Compared with before treatment, patients with dysmenorrhea and anemia both significantly reduced with a statistically significant difference(P<0.01). Conclusion: TB type thermal balloon endometrial ablation has a significant efficacy with high safety for the treatment of abnormal uterine bleeding, which could have clinical promotion practice.

Occult form of premature ovarian insufficiency

Premature ovarian insufficiency (POI) is a life-changing diagnosis, with profound physical and psychological consequences. Despite the description of different genetic, immune and iatrogenic factors of POI, the etiology of most cases of this disease are unexplained, and optimal management strategies are still unclear. Recent data showed that POI may have a long period of oligomenorrhea before the fully developed form (complete ovarian failure stage), with the occurrence of amenorrhea and climacteric symptoms. The main problem in the recognition of early stages of POI is the lack of proper diagnostic criteria. Patients with an undiagnosed occult form of POI may present with menstrual irregularities, unexplained infertility or repeated IVF failures. We evaluated 23 patients with unexplained oligomenorrhea and/or infertility. After a proper evaluation of these patients, a low ovarian reserve was identified, and an occult form of POI was diagnosed.

Disordered eating, amenorrhea, and substance use and misuse among professional ballet dancers: Preliminary analysis.

Substance use and misuse (SUM), eating disorders (ED) and consequent amenorrhea (AM) occur frequently in professional ballet dancing. The objective of this study has been to explore the prevalence and association between ED, AM and SUM in ballet. The sample comprised 21 ballet dancers, 23.1±4.5 years old, members of the professional National Ballet Ensemble from Croatia. Variables were collected by questionnaires examining SUM, occurrence of amenorrhea, and corresponding ballet-specific and socio-demographic factors (Questionnaire on Substance Use - QSU) and the level of ED (Brief Eating Disorder in Athletes Questionnaire - BEDA-Q). Smoking is prevalent in 40% of dancers (25% smoke on a daily basis), 36% often use analgesics, and 25% engage in binge drinking at least once a month. Smoking and binge drinking are less frequent in ballerinas with a higher academic level (r = 0.60 and r = 0.54 for binge drinking and smoking, respectively; p < 0.05). Alcohol drinking is higher among dancers who consume analgesics more often and those with a higher BEDA-Q score (r = 0.53 and r = 0.54 for analgesics and BEDA-Q, respectively; p < 0.05). Amenorrhea is more prevalent among those dancers with a higher BEDA-Q score. Women who consume nutritional supplements are less likely to use analgesics (Mann Whitney U test = 2.11; p < 0.05). Efforts seeking to prevent ED in ballet should target dancers who consume alcohol to a greater extent. Future studies should specifically explore the less frequent consumption of analgesics among dancers who consume nutritional supplements.

Downregulation of microRNA‑146a inhibits ovarian granulosa cell apoptosis by simultaneously targeting interleukin‑1 receptor‑associated kinase and tumor necrosis factor receptor‑associated factor 6.

Premature ovarian failure (POF), an ovarian disorder of multifactorial origin, is defined as the occurrence of amenorrhea, hypergonadotropism and hypoestrogenism in females <40 years old. Apoptosis of ovarian granulosa cells is important in POF and understanding the regulatory mechanism underlying ovarian granulosa cell apoptosis may be beneficial for the management of POF. Increasing evidence suggests that microRNAs (miRs) have a regulatory function in oocyte maturation and ovarian follicular development. In the present study, the expression of miR‑146a in plasma and ovarian granulosa cells obtained from patients with POF, its effect on the apoptosis of ovarian granulosa cells and the possible underlying mechanisms were examined. The present study demonstrated that compared with the control groups, the expression of miR‑146a in the plasma and in ovarian granulosa cells of patients with POF was significantly upregulated. Furthermore, it was found that miR‑146a simultaneously targeted interleukin‑1 receptor‑associated kinase (IRAK1) and tumor necrosis factor receptor‑associated factor 6 (TRAF6), which regulated the activity of nuclear factor‑κB and IκBα. In addition, the results demonstrated that inhibition of the caspase cascade by caspase inhibitors attenuated the effects of miR‑146a on ovarian granulosa cell apoptosis. Taken together, these results suggest that miR‑146a has an important promoting effect on the apoptosis of granulosa cells by targeting IRAK1 and TRAF6 via the caspase cascade pathway. These results may be useful for the management of POF.

Chemotherapy-induced amenorrhea in patients with breast cancer: basic mechanisms and diagnostic criteria of ovarian dysfunction

Occurrence of amenorrhea during chemotherapy in patients with breast cancer, some authors regard as a method of drug suppression of ovarian function. Chemotherapy-induced amenorrhea, due to the toxic effect of chemotherapy on the ovaries. Its appearance depends on the age of the patient, and the duration of chemotherapy protocol, as well as the cumulative dose of chemotherapy. Chemotherapy-induced amenorrhea occurs in 70% of premenopausal women, 40% of patients with breast cancer before age 40 years and 90% of women over 40. Several clinical trials show that the occurrence of amenorrhea during chemotherapy in patients with hormone-dependent breast cancer before age 50 improves survival. However, the absence of menstruation due to chemotherapy is not always an indication of adequate suppression of hormone-producing function of the ovaries and / or the onset of menopause. In this revue the main physiological mechanisms of chemotherapy-induced amenorrhea, as well as criteria for the diagnosis and clinical significance of various disorders of ovarian-menstrual cycle in premenopausal patients with breast cancer are discussed.

Acylated Ghrelin and Leptin in Adolescent Athletes With Amenorrhea, Eumenorrheic Athletes and Controls: A Cross-Sectional Study

Previous reports suggest that adolescent endurance athletes such as gymnasts and swimmers may be at higher risk of amenorrhea (AA) than other adolescent athletes. Neuroendocrine factors that differentiate athletes with AA from eumenorrheic athletes (EA) have been investigated but are not completely understood. Two neuroendocrine peptides, leptin and ghrelin, appear to be involved in regulation of the hypothalamo-pituitary-gonadal axis. Low leptin levels and high ghrelin levels have been implicated in the occurrence of amenorrhea in adult athletes. The investigators hypothesized that blood levels of leptin and/or ghrelin could predict levels of gonadal steroids in adolescent athletes and identify which will develop ammenorhea. This cross-sectional study compared the levels of leptin, ghrelin, and gonadal steroids among adolescent athletes with AA, EA, and nonathletic controls at a large urban hospital. The study enrolled 58 adolescent girls, 12-18 years old, including 21 AA, 19 EA and 18 nonathletic controls. There was no history of amenorrhea or menarchal delay in the nonathletic controls. Active ghrelin, leptin, estrogen (E 2 ), and testosterone were measured in fasting blood. The body mass index (BMI) in AA was significantly lower than among EA and controls at baseline (P = 0.003). Log active ghrelin levels were significantly higher in AA compared to the other two groups (P < 0.0001); the difference was maintained after controlling for BMI Z-scores (P = 0.0007). Leptin levels were lower in AA compared to the other two groups (P < 0.0001), but did not remain significant after controlling for BMI Z-scores. Total testosterone levels were lower among AA compared to the EA and controls (P = 0.002), and the differences remained significant after controlling for BMI Z-scores (P = 0.03. There was a significant trend for lower E 2 scores among AA than the EA (P = 0.07), but the effect was not significant after controlling for BMI Z-scores. Inverse associations of log active ghrelin with testosterone were noted (P = 0.05), whereas there were positive associations of leptin with testosterone (P = 0.05) and log E 2 (P = 0.01). These data show that ghrelin and leptin are independent predictors of levels of gonadal steroids. The investigators conclude from these findings that lower leptin levels and especially higher ghrelin levels may predict which athletes will develop amenorrhea.

Amenorrhea, Pregnancy, and Pregnancy Outcomes in Women Following Spinal Cord Injury: A Retrospective Cross-Sectional Study

ObjectiveTo assess the prevalence of amenorrhea and pregnancy as well as pregnancy outcomes following spinal cord injury (SCI) in women. MethodsIn this retrospective cross-sectional study, women with SCI were interviewed regarding demographic data, details about the timing and type of SCI they sustained, whether the neurologic deficit was complete or incomplete, and reproductive history. The study was initiated in September 2001 and lasted 3 years. Measures were compared for significance with the level of injury and extent of neurologic deficit using descriptive statistics, analysis of variance, and 2-tailed t tests. ResultsOf 128 women, 53 (41.4%) had postinjury amenorrhea. The amenorrhea was transient in 50 of 53 women. SCI occurred at the mean (± SD) age of 27 ± 9 years. In this group the lesions were at thoracic spine in 35 (66%), cervical spine in 16 (30%), and lumbar spine in 2 (4%). Neurologic deficit was complete in 31 women (58%) and incomplete in 22 (42%). The occurrence of amenorrhea was not influenced by the extent of neurologic deficit. Of 50 women who experienced transient amenorrhea, 10 (20%) became pregnant (6 livebirths, 4 elective terminations). Mean duration of amenorrhea was 7.96 ± 10.9 months; there was no significant difference between mean duration of amenorrhea in women who got pregnant vs those who did not (6.4 ± 3.8 months vs 15.8 ± 30.8 months; P = .34). Pregnancy rate was significantly higher among those who sustained injury at a younger age (21.6 ± 5.3 years vs 28.3 ± 9.3 years;P = .033). ConclusionsLevel of injury did not influence duration of amenorrhea or occurrence of pregnancy. Women who experience transient amenorrhea after SCI may achieve successful pregnancies. (Endocr Pract. 2008; 14: 437-441)

Association between the polymorphisms in protein L‐isoaspartate (D‐aspartate) O‐methyltransferase gene and premature ovarian failure

Premature ovarian failure (POF) is defined as the occurrence of amenorrhea before the age of 40 years. It includes primary amenorrhea characterized by absent menarche and secondary amenorrhea represented cessation of ovarian function before the age of 40 years. POF is a polygenic disease, so we performed a whole genome association study to reveal some important genes associated with POF. In this study, we found several regions which were associated with POF. One of the regions strongly associated with POF was on chromosome 6 and encoded protein L‐isoaspartate (D‐aspartate) O‐methyltransferase (PCMT1). We identified that four polymorphisms in PCMT1 gene encoding a protein repair enzyme were associated with POF. Then three polymorphisms formed a haplotype block and were in perfect linkage disequilibrium (LD) through LD test. Haplotype1 had significantly higher frequency in the POF group, while haplotype 2 had significantly higher frequency in the matched control group. Therefore we suggest that ht1 was significantly associated with susceptibility to POF occurance. In contrast, ht2 was significantly associated with resistance to it.

Body mass index, body fat mass and the occurrence of amenorrhea in ballet dancers

To evaluate the connection between menstrual disorders and body fat mass, we examined a group of 30 ballet dancers and a group of 30 non-athletic girls (controls). Body mass index (BMI) was calculated and percent body fat (FAT%) was measured using the bioelectrical impedance method. A questionnaire was used to obtain age at menarche and duration of menstrual cycles. Ballet dancers had significantly lower values of BMI (18.56 ± 1.53 vs. 19.96 ± 2.12 kg/m2) and FAT% (18.85 ± 4.50 vs. 23.41 ± 4.34%) compared with controls. According to BMI, 50.0% of ballet dancers and 23.3% of the control group were underweight. Of underweight ballet dancers, 66.7% had lower values of body fat, while most underweight girls from the control group had normal body fat. Normal-weight obesity was registered in 40.9% of the control group and in 6.7% of ballet dancers. Amenorrhea was found in 20.0% and oligomenorrhea in 10.0% of ballet dancers. Ballet dancers more frequently had later appearance of menarche and menstrual cycles of longer duration than did non-athletic girls. A significant negative correlation was found between menstrual cycle duration and FAT% among ballet dancers (r =–0.415). To prevent complications caused by changes of body fat mass, we conclude that body composition assessment in ballet dancers is very important.

Risk of Ovarian Failure and Pregnancy Outcome in Patients With Lupus Nephritis Treated With Intravenous Cyclophosphamide Pulse Therapy

Ovarian failure resulting from treatment with cyclophosphamide (CY) has become an increasing concern in patients with systemic lupus erythematosus (SLE) as survival has improved. It is a risk factor for significant morbidity in premenopausal women. This study examined the risk of ovarian failure and outcomes of pregnancy in 67 women having SLE and renal biopsy findings of class III or class IV proliferative lupus nephritis. The women were to receive intravenous CYC (IVCYC) pulse therapy in a dose of 0.5 to 0.75 mg/m2 monthly for 6 months, followed by a pulse every 3 months for 18 months longer. All the women received more than 2 IVCYC treatments. The mean number of IVCYC pulses was 8.8, and the mean dose administered was 988 mg per pulse. Ovarian failure was defined as sustained amenorrhea without resumption of menstruation. Follow up averaged 74.4 months, or slightly longer than 6 years. Amenorrhea developed in 25 women, 37% of the total, and 10 of them (15%) had sustained, presumably permanent amenorrhea. Women with ovarian failure were significantly older than the others and received higher cumulative doses of CYC. On logistic regression analysis, both older age at the start of treatment and the cumulative dose of CYC were independent risk factors for ovarian failure. Fifteen women had a total of 19 pregnancies. The mean interval between withdrawal of IVCYC pulse treatment and pregnancy was 46 months. Abortion was induced in 2 instances, once because the patient did not want to have a child and once because of a disease flare 9 weeks after conception. The remaining 17 pregnancies were uncomplicated and culminated in the delivery of healthy infants, none of whom had congenital anomalies or perinatal illness. After excluding women with ovarian failure and those using contraception, the occurrence of amenorrhea, apart from its duration, was a risk factor for pregnancy failure. Unless amenorrhea develops, successful pregnancies clearly are possible in women with proliferative lupus nephritis after IVCYC pulse treatment is withdrawn.

Continuous hormone replacement therapy for menopause combining nomegestrol acetate and gel, patch, or oral estrogen: a comparison of amenorrhea rates

This open-label, prospective, randomized, multicenter trial compared the incidence of amenorrhea in 54 postmenopausal women (mean age, 54.9 ± 0.6 years) who underwent six 4-week cycles of continuous hormone replacement therapy combining a progestin—nomegestrol acetate 2.5 mg/d—plus one of three estrogens: percutaneous 17β-estradiol gel (1.5 mg/d, group A), transdermal 17β-estradiol patch (50 μg/d, group B), or oral estradiol valerate (2 mg/d, group C). Based on an intent-to-treat analysis, the rate of amenorrhea varied significantly according to which estrogen preparation was used. Calculated cycle by cycle, rates of amenorrhea were 67% to 83% for group A, 25% to 56% for group B, and 53% to 61% for group C. Overall rates of persistent amenorrhea were not statistically different between groups for cycles 1 through 3, but for cycles 4 through 6, significantly more women in groups A and C (67% and 46%, respectively) experienced amenorrhea than did those in group B (12%). Amenorrhea rates for the entire six-cycle period were 78% for group A, 48% for group B, and 60% for group C. These differences were not statistically significant. The differences in rates could not be attributed to endometrial atrophy, since when measured by transvaginal sonography, endometrial thickness did not differ significantly between groups. Of the original population, 7% withdrew prematurely because of bleeding. The data for all three groups confirmed that in two out of three women, the occurrence of amenorrhea during the first three cycles predicted continuation of amenorrhea during subsequent cycles and that for 51% of women, ≤10 days of bleeding during the first three cycles predicted amenorrhea during the last three cycles. Calculated as a function of the number of women included in the trial, the percentage of amenorrheic women (evaluated cycle by cycle or for the second three-cycle period) was highest when the progestin was combined with percutaneous 17β-estradiol gel, although findings were similar with estradiol valerate. The percutaneous 17β-estradiol gel was also associated with a higher percentage of amenorrheal cycles than was estradiol valerate or transdermal estrogen, although differences were significant only in comparison with the transdermal formulation. This difference may have positive clinical implications.

The comparative trial of TCu 380A IUD and progesterone-releasing vaginal ring used by lactating women

The objective of this paper was to compare the efficacy, acceptability, safety, and bleeding patterns of TCu 380A intrauterine device (IUD) and progesterone-releasing vaginal ring used by breastfeeding women. The study population included 97 breastfeeding women using IUD and 100 women using vaginal ring. Of the IUD users, no insertion failure, perforation, or accidental pregnancy occurred in 12 months. There was one IUD expulsion. There were no discontinuations of IUD due to medical reasons other than expulsion. The total discontinuation rate was 2.3%. In the ring group, no accidental pregnancy occurred. The major reasons for discontinuation were ring use-related problems and vaginal problems. The total discontinuation rate was 65.4% within 1 year. The frequency of any one complaint among the ring users was higher than that among the IUD users. There were no differences in the proportion of women having no sexual activity and in the weight of their babies between the two groups. Compared with the IUD users, the median number of bleeding/spotting (B/S) episodes and B/S days of the vaginal ring users were fewer; consequently, the mean length of B/S-free interval was longer in all four reference periods; the mean length of B/S episode and segment were the same; the occurrence of amenorrhea was more frequent; in contrast, the proportions of normal bleeding patterns were fewer. The frequencies of prolonged bleeding, frequent bleeding, and infrequent bleeding patterns did not differ between the two groups. The percentage of irregular bleeding was fewer only in the first two reference periods. It is concluded that the TCu 380A IUD and progesterone-releasing vaginal ring used by breastfeeding women are safe and effective. The higher discontinuation rate of the ring users was mainly because of use-related problems. Breastfeeding women with TCu 380A IUD had better tolerance and acceptability. The TCu 380A IUD does not, but the progesterone-releasing vaginal ring does, suppress the recovery of ovarian function. However, once return of menstruation occurred, there were no differences in bleeding patterns between the two contraceptive methods.

Phenotypic evolution of classic 21‐hydroxylase deficiency

We describe a female patient who was diagnosed and treated at birth for a classic form of salt-losing congenital adrenal hyperplasia. At 17 years of age, against medical advice, she discontinued both mineralocorticoid and glucocorticoid replacement with no resulting clinical symptoms other than the occurrence of amenorrhoea. Steroid metabolites revealed significant abnormalities of the renin-angiotensin-aldosterone axis, as well as of pituitary-adrenal function. Analysis of our patient's DNA showed only one deleterious CYP21 mutation, an intron 2 base pair change activating a cryptic splice site. We speculate that expression of this patient's CYP21 genes may be altered by the effects of ageing or by changes in the steroid milieu.

Sexual function in women with advanced multiple sclerosis.

Changes in sexual function in 47 women with advanced multiple sclerosis are described. Twenty eight (59.6%) of the women reported decreased sexual desire. Seventeen (36.2%) reported decreased lubrication. Five (10.6%) others did not know if they lubricated or not. Eighteen women (38.3%) reported diminished orgasmic capacity and six (12.8%) others had never had an orgasm. Sensory dysfunction in the genital area was experienced by 61.7% of the women and 76.6% had weakness of the pelvic muscles. Sixty six per cent had bowel problems and 89.4% had bladder dysfunction. The changes in sexual function correlated both with neurological symptoms from the sacral segments, such as weakness of the pelvic floor and bladder and bowel dysfunction, and to other symptoms such as ataxia and vertigo as well as with age and the occurrence of amenorrhoea. A significant correlation was found between expanded disability status scale (EDSS) score and cohabitation. Problems with sexual function were reported significantly more often by women with lower EDSS scores. Most women (83%) found the interview a positive experience.

Melatonin rhythms in women with anorexia nervosa and bulimia nervosa.

To discern whether the multiple neuroendocrine-metabolic dysfunctions observed in women with anorexia nervosa (AN) and bulimia nervosa (BN) are associated with altered diurnal variations in serum melatonin profiles, we compared cycling and amenorrheic women with normal weight BN (n = 8) and AN (n = 7) to 21 normal cycling controls. Endogenous depression, which has confounded prior studies of melatonin profiles in women with eating disorders, was excluded in all subjects. Serum samples for melatonin measurements were obtained at frequent intervals (every 20 min) in a controlled light-dark environment, and cycling women were studied in the early follicular phase of the menstrual cycle. Mean (+/- SE) peak melatonin levels were similar in AN, BN, and controls (325 +/- 43, 310 +/- 33, and 334 +/- 30 pmol/L, respectively). The time of melatonin peak, the time of onset and offset of the nocturnal serum melatonin excursion, and the duration of the nocturnal elevation were also similar in the three groups. Analysis of covariance revealed no independent effects of age or time of year on the data. Moreover, when subjects were separated into those with and without menstrual cyclicity, no significant differences in any parameter of melatonin diurnal variation were observed. Taken together, these data suggest that pineal melatonin secretion is unaltered in women with eating disorders, in whom depression is excluded, and that the frequent occurrence of amenorrhea in this population is not mediated by melatonin.

Weight loss and menstrual cycle: clinical and endocrinological evaluation.

This study explores the clinical and endocrine implications of weight loss. The frequency of menstrual abnormalities was found to be greatly influenced by reduction in body weight. The occurrence of amenorrhea appeared to be proportional to the rate of weight loss, while regular cycles and luteal phase deficiency were inversely correlated to weight loss. Endocrine variations were noted. Significant decreases in luteinizing hormone and follicle stimulating hormone levels occurred only in amenorrheic patients with a weight loss higher than 20%. The estradiol level decreased in proportion to the reduction in body weight. Cortisolemia increased in all patients, with higher values apparent in amenorrheic women presenting with a weight loss higher than 20%. The prolactin values were normal except in amenorrheic patients who had lower levels. A reduction of insulin levels occurred in all groups, with a significant difference found only in amenorrheic women in Group C (weight loss higher than 20%). The data suggest that weight loss in young women causes alterations in the menstrual cycle mainly through two mechanisms involving both the hypothalamic-pituitary-adrenal axis and ovarian steroidogenesis together with estrogen catabolism.

CONTROLLED TRIAL OF ADJUVANT CHEMOTHERAPY WITH MELPHALAN FOR BREAST CANCER

370 patients who had carcinoma of the breast with involved axillary lymph-nodes were randomised after total mastectomy and axillary clearance to receive either no additional treatment or melphalan 6 mg/m2 daily for 5 days every 6 weeks for sixteen cycles. There was a trend towards longer relapse-free survival (RFS) in patients treated with melphalan, but this was not significant either in the whole series or in sub-groups according to menopausal status or extent of nodal involvement. In patients receiving melphalan RFS was not significantly affected by either the occurrence of amenorrhoea or the dosage of melphalan received. Overall survival did not differ significantly between the two groups. The results of this trial suggest that there is no place for the use of melphalan as adjuvant therapy in the management of early breast cancer.

Psychological and nutritional factors in disturbances of menstrual function and ovulation.

Evidence has shown that amenorrhea can be induced by emotional upheavals such as are present during wartime psychiatric illness such as schizophrenia and feeding disorders. Anxiety in potential gas chamber victims induced amenorrhea in 54% of women. Food deprivation in Holland between 1944 and 1945 caused menstruation cessation in 50% of urban women. In feeding disorders such as anorexia nervosa a 100% occurrence of amenorrhea has been reported. Hormonal studies in anorexic patients show abnormal total gonadotrophic activity (TGA) low basal levels and absent cyclical fluctuations. Results of a study of obese patients treated with a weight-reducing regimen suggest that food restriction and weight loss are more influential in lowering the basal levels of TGA and less significantly influential on cyclical activity. Studies done on some species of animals suggest that basal levels and TGA cycles are controlled by different central nervous mechanisms. To what extent these mechanisms affect amenorrhea of emotional origin and anorexia nervosa are still unknown but an association has been made between amenorrhea and emotional or psychiatric illness and feeding disorders.

Pain in the polycystic ovary syndrome

1.1. Four patients with polycystic ovary syndrome are presented, in whom abdominal pain was the predominant presenting complaint.2.2. The occurrence of amenorrhea, irregular vaginal bleeding and an apparently unilateral adnexal mass in polycystic ovary syndrome is not unusual. If one adds low abdominal pain and tenderness to this, this group of patients must be included in the differential diagnosis of ectopic pregnancy.