PubMed · 9204187
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L Katznelson, A Klibanski. 1997. Prolactinomas.. https://doi.org/10.1007/978-1-4615-6355-6_3
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In the Netherlands many women stop breastfeeding in the first few months postpartum. In 1997, only 16.9% of all 3-month-old babies received full breastfeeding. One of the causes may be insufficient support by the medical profession. A second factor is that often combined oral contraceptives are prescribed to breastfeeding women. As it has been shown that estrogens in these contraceptives inhibit lactation, this is probably one of the reasons why breastfeeding frequently fails in this country. WHO advises not to use estrogens during lactation. According to recent research the lactational amenorrhoea method of contraception (LAM) is highly effective during the first 4 months postpartum. In the 5th and 6th month the effectiveness is strongly dependent on the accuracy by which the conditions are met. The medical profession should pay more attention to the support of breastfeeding and contraception in relation to each other.
Functional hypothalamic amenorrhea are frequently observed. Body weight, body composition, eating attitudes, exercise are potent modulators of gonadotrop axis. Animal studies and clinical observations stress the fact of a major impact on ovary function of starvation or caloric restriction, weight loss and fat mass deficiency, eating disorders, stress or high intensive exercise training. From a pathophysiological point of view, insulin, IGF's system, leptine and central neuromediators are a link between nutrition and the gonadotropic axis. Initial clinical evaluation may strongly suggest the environmental origin of the amenorrhea. Basal hormonal evaluation (gonadotropins, prolactin, androgens ...) excludes other diseases and specialised evaluations [basal metabolic rate (BMR), Free T3 ...] could confirm the diagnosis. A low BMR, and a low Free T3, a normal FSH level with a low LH level suggest the nutritional origin of the amenorrhea. Improvement of nutritional intake and body composition with a psychological follow up may reverse the gonadotropin deficiency. If this deficiency persists hormonal replacement therapy is added in order to prevent the short or long term consequences (osteoporosis) of hypoestrogenism.
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