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Clinical implications for the endometrium of hormone replacement therapy
Published in Barry G. Wren, Progress in the Management of the Menopause, 2020
In the same study, the majority of women who received cyclic combination therapy for the last 14 days of each 28-day cycle along with the CE 0.625 mg/day in both cases)15. experienced withdrawal bleeding that began, in the next cycle, within 3 days of the day of onset in the previous cycle throughout all 13 evaluable cycles (80% and 65.9% for women who took MPA at 5.0 and 10.0 mg, respectively,
The female reproductive system
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Anovulatory cycles typically occur at the menarche and around the menopause (perimenopausal bleeding). Failure of ovulation leads to continued endometrial proliferation. Withdrawal bleeding then occurs either when the endometrium becomes too thick to be supported by its blood supply, or as a result of fluctuation in oestrogen levels. If ovulation continually fails to occur, then endometrial proliferation may be marked, leading to simple hyperplasia (hyperplasia without atypia) of the endometrium and, in some patients, atypical hyperplasia and invasive carcinoma. This is particularly true in patients with polycystic ovary syndrome (PCOS), one of the hallmarks of which is failure of ovulation. In another group of patients, ovulation occurs but the secretory phase is abnormal. This may take the form of a coordinated delay in secretory transformation, asynchrony between glands and stroma, and, perhaps most commonly, irregular ripening when only some glands develop secretory changes. Various physiological defects – both ovarian and endometrial – are involved in this group of abnormalities. Irregular shedding occurs when fragments of endometrium do not shed during menstruation but persist into the next cycle.
Reproductive health care for adolescents with developmental delay
Published in Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo, Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Elisabeth H. Quint, Susan D. Ernst
Once the decision is made to treat the patient's cycles, based on the previously outlined principles, a treatment goal is decided. This can be to decrease heaviness of flow, relieve pain or symptoms, provide contraception, or achieve amenorrhea. A method causing unpredictable bleeding may be less desirable than infrequent but predictable withdrawal bleeding. Obtaining complete amenorrhea by any method is difficult.
POI after chemotherapy and bone marrow transplant may mimic disorders of sexual differentiation – a case report of a patient with primary amenorrhea and 46, XY karyotype
Published in Gynecological Endocrinology, 2020
Jagoda Kruszewska, Sandra Krzywdzińska, Monika Grymowicz, Roman Smolarczyk, Blazej Meczekalski
A 24-year-old woman was admitted to the Department of Gynecological Endocrinology suspected of premature ovarian insufficiency (POI). Her past medical history revealed chemotherapy because of acute lymphoblastic leukemia (ALL) when she was 7, with a late relapse and total body irradiation followed by bone marrow transplantation at the age of 12. On admission, she reported to be free of the disease and did not take any medication because of leukemia. As an adolescent, the patient noticed a lack of menstrual flow and was presented with poor secondary sex characteristics to the pediatric department. Initially, she was prescribed estrogen supplementation (2 mg/day orally). Later progesterone was added to induce withdrawal bleeding. First menstruation occurred at the age of 18, but was only achieved by hormonal therapy (2 mg/day estradiol valerate with 0.5 mg norgestrel for 10 days in the month), which she continued since then and overdrew 6 months prior to consultation in the clinic. The clinical manifestation was suggestive of impairment of the ovarian tissue by the chemotherapy, which is consistent with the development of POI.
Perrault syndrome with amenorrhea, infertility, Tarlov cyst, and degenerative disc
Published in Gynecological Endocrinology, 2019
Dania Al-Jaroudi, Saed Enabi, Malak Sameer AlThagafi
Infertility, described as the inability to conceive after a year of regular unprotected sex in women who are 35 years old or younger, remains a global problem [1]. Approximately 8–12% of couples within their reproductive age experience infertility [1]. Infertility cases range from common and simple cases, to a more complex occurrence. The rare genetic disease Perraults Syndrome (PS) that afflicts both males and females highlights an example of the latter. PS is classified into two subtypes: Type 1 leads to hearing loss in both genders and ovarian dysgenesis in females alone resulting in amenorrhea and infertility; Type 2 leads to neurological symptoms including ataxia and mental retardation in addition to the classical features [2–5]. The inheritance of PS is autosomal recessive [3,4]. The described heterogeneity in the clinical presentation of PS is most likely due to the mutations in six major disease causing-genes, namely CLPP, ERAL1, HARS2, HSD17B4, LARS2, TWNK [5–13]. These genes function in the maintenance of mitochondrial function. PS is diagnosed through the clinical presentation of sensorineural deafness and ovarian dysgenesis, or through genetic diagnostic through gene panels or exome sequencing [7]. The management options for PS include supporting the hearing loss through cochlear implantation, vibro-tactile devices and hearing aids. Regarding ovarian insufficiency, if the patient has primary amenorrhea in adolescence; hormone replacement therapy (HRT) is used to induce puberty. However, the administration of cyclic estrogen and progesterone to mimic the menstrual cycle can elicit withdrawal bleeding.
Comparative randomized study on the sexual function and quality of life of women on contraceptive vaginal ring containing ethinylestradiol/etonogestrel 3.47/11.00mg or 2.7/11.7mg
Published in Gynecological Endocrinology, 2019
Salvatore Caruso, Marco Panella, Giuliana Giunta, Maria Grazia Matarazzo, Antonio Cianci
In the field of oral contraception new active formulations, new regimens [1–3], and route of administration such as intravaginal monthly applied method [4] have been realized. However, as regards vaginal contraception, until recently, there has only been one contraceptive vaginal ring (CVR) (NuvaRing®, Msd, Italy) containing 2.7 mg of ethinylestradiol (EE) and 11.7 mg of etonogestrel (ENG); it has an external membrane of ethylene vinylacetate, containing 9% vinylacetate, through which 15 µg of EE and 120 µg of ENG are released daily [5]. After placement, the ring is kept in the vagina, on average, for a 3-week period of use, followed by a 1-week ring-free period, according to a traditional hormonal contraceptive (HC) regimen [6]. Withdrawal bleeding is to be expected within 2–3 days of ring removal. Subsequently, a new ring is placed and the cycle is repeated [7].