Resumption Of Regular Menses Research Articles

Osteoporosis recovery in severe anorexia nervosa: a case report

BackgroundOsteoporosis represents a common and severe complication in patients with anorexia nervosa (AN) that normally persists despite weight restoration and the resumption of regular menses. The condition may result in significant pain, injury, and disability.Case presentationWe report the only published case of a complete return to normal bone density following many years of severe osteoporosis in a severely malnourished patient with AN. We describe a patient with severe and enduring AN whose osteoporosis, with resultant fractures, was completely reversed. Available patient records, imaging, and laboratory data were evaluated.ConclusionsThis case represents a common yet often improperly treated complication of AN. It demonstrates the potential important clinical role that targeted medicines coupled with a multifaceted supplementation and lifestyle interventions, may have for some very malnourished patients with AN. Medications, in the treatment of osteoporosis in patients with severe AN, may decrease fracture risk, enhance overall bone density, and contribute to an improved quality of life.

Resumption of sexual activity and regular menses after childbirth among women infected with HIV in Malawi

Objective To determine the factors associated with resumption of sexual activity and regular menses after childbirth among women infected with HIV-1. Methods Information on sociodemographic, behavioral, and clinical factors was obtained from 2 HIV perinatal studies (NVAZ and PEPI trials) conducted in Malawi, 2000–2009. Factors associated with resumption of sexual activity and menses were analyzed using Cox proportional hazard models. Results A total of 1838 women from the NVAZ study and 2982 women from the PEPI study were included in the analysis. Resumption of sexual activity was primarily associated with sociodemographic factors (e.g. in the PEPI study, marital status [adjusted hazard ratio (aHR) 0.56, P < 0.001], use of contraceptive method [aHR 8.0, P < 0.001], and breastfeeding [aHR 0.52, P < 0.001]), whereas resumption of regular menses in the PEPI study was primarily associated with biological factors (e.g. plasma viral load [aHR 0.89, P < 0.006], and breastfeeding [aHR 0.23, P < 0.001). Conclusion HIV-infected women need adequate counseling to take into account their HIV infection status before resuming sexual activity after childbirth.

The effects of metformin on metabolic and cardiovascular risk factors in nonobese women with polycystic ovary syndrome

There are conflicting data regarding the effects of metformin in lean women with polycystic ovary syndrome (PCOS). Thus, our aim was to evaluate the effects of 6 months of metformin therapy on various metabolic and cardiovascular risk factors in lean women with PCOS. This was a prospective clinical study performed in a University hospital. Twenty nonobese PCOS women and 20 age- and BMI-matched healthy women were included in the study. Metformin (2550 mg/day) was administered for 6 months in women with PCOS. The hormonal and metabolic parameters were evaluated before and after metformin treatment. The main outcome measures were serum androgens, FSH, LH, oestradiol, 17-hydroxyprogesterone, glucose, insulin, lipid profile, lipoprotein(a) [Lp(a)] and homocysteine levels. In addition 24-h ambulatory blood pressure monitoring (ABPM) and carotid intima-media thickness (IMT) were taken. After 6 months of metformin therapy, women with PCOS had decreased LH, total testosterone, free androgen index and slightly increased SHBG levels. Metformin treatment resulted in resumption of regular menses in 12 (60%) patients, and in 8 (40%) of them serum progesterone level was compatible with ovulation. Glucose and insulin responses to oral glucose tolerance test (OGTT) and homeostasis model assessment of insulin resistance (HOMA-IR) did not improve after the metformin therapy. There were no significant changes in terms of cardiovascular risk factors such as lipids and homocysteine, IMT and ABPM. Metformin may have beneficial effects in lean PCOS women in terms of resumption of menses without any remarkable effect on metabolic and cardiovascular risk factors.

Increased insulin-like growth factor-I levels in women with polycystic ovary syndrome, and beneficial effects of metformin therapy

We aimed to investigate whether metformin would reverse the endocrinopathy of polycystic ovary syndrome (PCOS), allowing resumption of cyclic ovulation and regular menses, and whether metformin causes any change in the serum concentration of insulin-like growth factor-I (IGF-I) in patients with PCOS. Fifty-eight women with PCOS participated in the study and received metformin at a dose of 850 mg three times a day (total 2550 mg) for 16 weeks. Serum concentrations of luteinizing hormone, follicle stimulating hormone, estradiol, free testosterone, total testosterone, 17-hydroxyprogesterone, dehydroepiandrosterone sulfate, fasting insulin, IGF-I, sex hormone binding globulin and insulin-like growth factor binding protein-1 (IGFBP-1) were evaluated before and after metformin treatment. Patients were divided into two groups as responders and non-responders according to the achievement of regular menstrual periods. The mean IGF-I levels decreased significantly on metformin therapy. After 16 weeks of metformin treatment, 55.17% of PCOS patients achieved regular menses. Only the change in serum levels of progesterone and IGF-I on metformin were statistically significant between responders and non-responders; metformin-induced decremental change in IGF-I levels were greater in responders. In conclusion, we observed that elevated IGF-I levels may have a crucial role in many consequences of PCOS in addition to hyperinsulinemia. By decreasing insulin and IGF-I levels, metformin therapy offers additional beneficial effects in resumption of regular menses. Thus, in PCOS patients with elevated levels of IGF-I, metformin may be considered as an appropriate agent to be used for the regulation of menstrual cycles.

Potential Utility of Insulin Sensitizers in the Treatment of Patients with Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a form of functional ovarian hyperandrogenism. It is one of the most common endocrinologic disorders in women of reproductive age. Women with PCOS may present with menstrual irregularities, chronic anovulation, infertility, obesity and hyperandrogenism. PCOS is associated with insulin resistance and hyperinsulinemia in most, if not all, patients. Besides its gynecological manifestations, PCOS is also associated with increased metabolic and cardiovascular risks. These risks are strongly linked to insulin resistance, and during recent years a novel therapeutic approach using insulin-sensitizing agents has been extensively investigated. In most studies conducted to date, metformin and the thiazolidinedione agent troglitazone have resulted in improved insulin sensitivity, resumption of regular menses and decreased serum androgen levels. Insulin-sensitizing agents may be a useful adjuvant therapy for women with PCOS.

Bromocriptine treatment of women with suspected pituitary prolactin-secreting microadenomas

The present study was designed to investigate the efficacy of bromocriptire in reducing serum prolactin (PRL) levels and in decreasing the size of PRL-secreting microadenomas. Bromocriptine, 5.0 mg, was administered daily for 2 years to 17 women who had galactorrhea, hyperprolactinemia, and hypocycloidal polytomographic evidence suggestive of a pituitary microadenoma. Serum PRL levels were normalized in 16 of 17 women during therapy. Associated with this was resumption of regular menses in 15 of 16 women with menstrual dysfunction and cessation of galactorrhea in 16 of the 17 women. Improvement in the roentgenographic appearance of the sella turcica occurred in two women. No progression in tumor size was found during the course of therapy. Side effects attributed to bromocriptine were minimal, transient, and usually well tolerated. These data suggest that bromocriptine is an appropriate therapeutic modality for PRL-secreting pituitary microadenomas.

Interactions between psychosomatic conflicts and gonadotropin secretion.

This present paper represents an attempt to correlate hormonal patterns and psychoanalytical data in 30 patients with secondary amenorrhea. Based on psychoanalytical data and the maximal LH response to GnRH, which were obtained independently, the patients were divided into two groups presenting differing psychosomatic symptomatologies. Patients with severe psychosomatic disease (group A) complaining predominantly of somatic discomfort, exhibited a weak pituitary response to GnRH. Patients presenting mainly mental symptoms were found to be less affected by the psychosomatic disease (group B). The LH responses to GnRH were only moderately impaired in these patients. Seven patients of group A underwent psychotherapy, resulting in a resumption of regular menses in 4 patients. Eight untreated controls of this group who remained amenorrheic exhibited unaltered gonadotropin in levels. All patients of group B being treated by psychotherapy resumed regular menses, while 5 of 7 control patients developed spontaneous menstruation. The progress of sexual maturation in these patients is correlated with increasing pituitary LH response to GnRH. The present study provides evidence that the degree of a psychosomatic disturbance resulting in secondary amenorrhea is reflected by the pattern of plasma LH after GnRH stimulation.

Abnormal regulation of prolactin secretion after successful surgery for prolactin-secreting pituitary tumours.

Patients with prolactin-secreting pituitary tumours have a diminished prolactin (PRL) response after administration of a variety of stimulatory agents, including thyrotrophin-releasing hormone (TRH), chlorpromazine (CPZ) and insulin-induced hypoglycaemia. We examined responses to these agents in sixty-seven women with PRL-secreting tumours before and after trans-sphenoidal surgery. Twenty-nine of the women were cured as defined by restoration of normal serum PRL concentrations and resumption of regular menses. One year following trans-sphenoidal surgery, patients with normal PRL concentrations and regular menses had normal PRL responses to TRH, while the responses to CPZ and insulin hypoglycaemia were not improved. The reversible impairment of PRL response to TRH reflects suppressed function of normal PRL-secreting cells, and the persistence of abnormal PRL responses to provocative stimuli after successful tumour removal may reflect some fundamental defect in the regulation of PRL secretion in patients with PRL-secreting adenomas. When growth hormone (GH) reserve after insulin hypoglycaemia was represented as the mean absolute increment above the basal concentration and compared with normal subjects, women with PRL-secreting tumours had a diminished response that returned to normal after successful surgery. This reversible impairment of GH secretion is not adequately reflected by standard criteria for GH response and suggests that PRL may have a role in the regulation of GH secretion.

Predictors of the outcome of transsphenoidal surgery for prolactin-secreting pituitary adenomas.

Sixty-seven women who underwent transsphenoidal resection of PRL-secreting pituitary adenomas between 1976 and 1979 were separated into categories according to the manner of their clinical presentation. Forty-one had oral contraceptive-related onset of amenorrhea-galactorrhea, 5 had pregnancy-related onset of amenorrhea-galactorrhea, 5 had primary amenorrhea, and 16 had the spontaneous onset of amenorrhea-galactorrhea unrelated to estrogen use. Surgical success, defined as the resumption of regular menses and normalization of serum PRL concentration, was achieved in 54% of those with estrogen-related onset of amenorrhea-galactorrhea compared with 19% in the other group. The analysis of multiple preoperative features, including clinical classification, age, preoperative PRL concentration, and duration of amenorrhea-galactorrhea by logistic regression, demonstrated that the clinical classification was the most important factor in predicting the outcome of transsphenoidal surgery. It should be a prime consideration in the selection of therapy for PRL-secreting adenomas.

Use of brom-ergocryptine in treating amenorrhea/galactorrhea.

Seven women with amenorrhea and galactorrhea, and no evidence of pituitary adenoma, were treated with brom-ergocryptine for two to 24 weeks. All seven patients had the resumption of regular menses within eight weeks, but six patients required 24 weeks of therapy to completely cease lacting. Two of the five women attempting to conceive became pregnant. Four of the five nonpregnant patients had a total recurrence of their symptoms after discontinuing the drug. Brom-ergocryptine appears to be very effective in inhibiting prolactin secretion and thus reestablishing normal ovulatory menstrual cycles and fertility.