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PubMed1977

Bromocryptine therapy in cases of amenorrhea-galactorrhea.

Of 28 patients presenting with amenorrhea-galactorrhea, pituitary tumors were confirmed in eight. Six patients had occult hypothyroidism and the rest had an endocrine profile suggestive of pituitary tumor or of an idiopathic etiology. Treatment with bromocryptine resulted in suppression of the inappropriate lactation and restoration of regular menstrual function. In five cases, however, the galactorrhea was only diminished and in four of these cases, normal ovarian function did not return. Of the 19 patients that were seeking fertility and continued the medication for at least 20 days, nine pregnancies resulted. A similar response to bromocryptine was observed regardless of the underlying cause of the amenorrhea-galactorrhea.

Adult↗
PubMed1977

Detection, evaluation, and treatment of pituitary microadenomas in patients with galactorrhea and amenorrhea.

Over a period of two and a half years, 34 women with galactorrhea or amenorrhea, all with an abnormal sellar polytomogram, underwent transsphenoidal microsurgical exploration of the sella. Eighteen women and microadenomas (less than or equal to 1 cm. in diameter), seven had macroadenomas (greater than than 1 cm. in diameter), and five had unidentified lesions. Only one women had a normal pituitary gland. Three women had cryosurgery without biopsy. Preoperatively, hyperprolactinemia occurred in 24 of 25 women with adenomas and two of five with nonadenomatous lesions. There were no operative deaths. Significant morbidity occurred in only three patients, none of whom had microadenomas. Postoperatively, menses resumed in 16 of the 17 women with microadenomas and in two of the seven with macroadenomas who presented with amenorrhea. Galactorrhea disappeared in 15 of the 17 women with microadenomas and in four of the seven with macroadenomas who presented with galactorrhea. In five patients with unidentified lesions, a return of menses occurred in two of four with previous amenorrhea, and galactorrhea abated in two of three who presented with lactation. We conclude that sellar polytomography in women with hyperprolactinemia is a useful technique technique for the diagnosis of pituitary adenomas, a lesion which may occur more frequently than previously realized. In addition, transsphenoidal microresection of microadenomas is safe and effective.

Adenoma↗
PubMed1977

Current concepts of prolacting physiology in normal and abnormal conditions.

Currently the physiology and pathophysiology of pituitary prolactin secretion are under intensive investigation. Development of sensitive, specific radioimmunoassays for hPRL and improved roentgenographic techniques have increased the diagnostic acumen for incipient pituitary microadenomas. Several modalities of treatment are available at the present time which can result in improvement in the clinical symptoms of the amenorrheagalactorrhea syndromes. Eponymic classification of amenorrhea-galactorrhea syndromes should be discarded and appropriate diagnostic studies initiated to determine the etiology of the inappropriate breast secretion and/or elevated serum hPRL level.

Adenoma↗
PubMedDate not supplied

[Indications, surgical modality and complications of hysterectomy for benign pathology: results of a Lombard study. Gruppo di Studio Lombardo sull'Isterectomia].

The results of descriptive epidemiological study on hysterectomy for benign conditions are presented. Between October 1990 and September 1991, 1189 surgeries for fibroids, disorders of menstruation and ovarian cysts performed in 15 gynaecological clinics in Lombardy (Northern Italy) were registered using standard sheets. Fibroids was the most common indication for hysterectomy (74.3% of total). Most surgeries were performed in women aged 40-59. We observed a relatively high frequency of longitudinal incision in young and thin women with small fibroids, a relatively high execution of bilateral oophorectomy in premenopausal women (35% of surgeries for fibroids or menstrual disorders), a median hospital stay of 12 days, a great variability in thromboembolic and antibiotic prophylaxis.

Adnexal Diseases↗
PubMed1986

Gonadotropin-releasing hormone (GnRH) physiology in men and women.

The combined approach used in studies of GnRH secretion provided a complimentary array of techniques with which to establish the program of amplitude (dose) and frequency of GnRH secretion in the physiologic state. Normative data in men and women were useful in formulating frequency estimates, which could then be applied to the task of replacement of GnRH in deficient (IHH) individuals. Comparison of the results of therapy with these 'ablation-replacement' models then allowed to arrive closer to the true amplitude or dose of exogenous GnRH required to duplicate the physiologic ideal. In addition to providing insight into the neuroendocrine control of reproduction, these applications provided treatment of various reproductive disorders in men and women. Further expansion of the efforts into other potential defects of endogenous GnRH secretion will ultimately uncover those disorders amenable to therapy.

Adolescent↗
PubMed1999

High nocturnal body temperatures and disturbed sleep in women with primary dysmenorrhea.

Primary dysmenorrhea is characterized by painful uterine cramps, near and during menstruation, that have an impact on personal life and productivity. The effect on sleep of this recurring pain has not been established. We compared sleep, nocturnal body temperatures, and hormone profiles during the menstrual cycle of 10 young women who suffered from primary dysmenorrhea, without any menstrual-associated mood disturbances, and 8 women who had normal menstrual cycles. Dysmenorrheic pain significantly decreased subjective sleep quality, sleep efficiency, and rapid eye movement (REM) sleep but not slow wave sleep (SWS), compared with pain-free phases of the menstrual cycle and compared with the controls. Even before menstruation, in the absence of pain, the women with dysmenorrhea had different sleep patterns, nocturnal body temperatures, and hormone levels compared with the controls. In the mid-follicular, mid-luteal, and menstrual phases, the dysmenorrheics had elevated morning estrogen concentrations, higher mean in-bed temperatures, and less REM sleep compared with the controls, as well as higher luteal phase prolactin levels. Both groups of women had less REM sleep when their body temperatures were high during the luteal and menstrual phases, implying that REM sleep is sensitive to elevated body temperatures. We have shown that dysmenorrhea is not only a disorder of menstruation but is manifest throughout the menstrual cycle. Furthermore, dysmenorrheic pain disturbs sleep, which may exacerbate the effect of the pain on daytime functioning.

Adult↗
PubMed1992

Sheehan's syndrome in a developing country, Nigeria: a rare disease or problem of diagnosis?

Over a five year period, 11 cases of Sheehan's syndrome were seen in the Endocrinology Unit of a teaching hospital in Ibadan, Nigeria. The mean age at diagnosis was 35.1 years; the mean parity was four and the average interval between the obstetric injury and diagnosis was 6.9 years. Four patients were in middle socio-economic class and seven were in low socio-economic class. The most frequent presenting symptoms were failure of lactation (11 out of 11 patients) and amenorrhoea (9 out of 11 patients). Seven patients had multiple endocrine insufficiency involving essentially all pituitary cell types. Six out of 8 patients were lost to follow-up. In a review of autopsy records over a 5-year period at the same institution, out of 1,951 post-mortem examinations, no additional cases of Sheehan's were found. With an average of about two clinical cases per year, it would seem that Sheehan's syndrome is still a relatively rare entity in this part of the world in spite of the poor level of obstetric care generally available. There is a need for increased awareness about this disease on the part of practitioners in developing countries in order to establish whether this rarity is real or it is due to missed diagnosis.

Adult↗
PubMed1998

Progestin receptor isoforms and prostaglandin dehydrogenase in the endometrium of women using a levonorgestrel-releasing intrauterine system.

This study has examined endometrial tissue in 14 normal women prior to insertion of a levonorgestrel-releasing intrauterine system (LNG-IUS) and thereafter longitudinally for up to 12 months post-insertion. The specific endpoints examined by immunohistochemistry were progesterone receptor (PR) subtypes A + B, oestrogen receptor (ER) and prostaglandin dehydrogenase (PGDH). Two antiprogesterone receptor antibodies, one specific to PR(B) subtype and the other to PR subtype A + B, were employed to examine the localization of both PR isoforms. The activity of PGDH, a progesterone dependent enzyme, was also measured. ER and PR(A+B) and PR subtype B were significantly down-regulated in glands and stroma in the presence of continuous intrauterine LNG delivery. There was an apparent increase in PR(A) immunoreactivity in endometrial glands between 6 and 12 months post-insertion. Consistent with down-regulation of both isoforms of PR was reduced glandular PGDH immunostaining following LNG-IUS insertion, and PGDH activity (as measured by metabolism of excess substrate in vitro). Furthermore, PGDH activity, known to be localized in the glands, significantly increased (P < 0.05) at 12 months post-insertion, coinciding with the observed increase in glandular PR(A+B) immunoreactivity at this time. Since the LNG-IUS suppresses the PR(B) so strongly, PR(A) is likely to be the subtype that mediates long term LNG action in the endometrium. PR(B) is the more suppressed of the two subtypes, and only PR(A) rises along with PGDH activity. Alterations to normal endometrial morphology and function, e.g. perturbation of normal sex steroid receptor expression, following exposure to high concentrations of local LNG, may play a role in the aetiology of bleeding disorders associated with the LNG-IUS. Further elucidation of local uterine mediators involved in the mechanism of bleeding problems is required.

Adult↗
PubMed1992

Organic mood disorder associated with the HAIR-AN syndrome.

The HAIR-AN syndrome is characterized by hyperandrogenism, insulin resistance, and acanthosis nigricans. The authors report the first case of an organic mood disorder associated with this condition that improved markedly in response to ovarian suppression with oral contraceptives. The proposed pathophysiology of this syndrome is also discussed.

Acanthosis Nigricans↗
PubMed1976

[Surgical procedures for sterilization of the women: certainty--complications (author's transl)].

The time (interval, postpartum, postabortum), location (uterus, mucus membrane of the oviducts, tubes), access (transcervical, transvaginal, trans-abdominal) and the actual method of sterilization for the women (surgical, electric, thermic, mechanical) can be differentiated and combined with each other in various ways. Today the usual procedure is sterilization by partial resection of the oviducts performed laparoscopically in the interval via electrocoagulation and surgically after delivery via periumbilical minilaparotomy. Laparoscopic sterilization via electrocoagulation has a rate of failure of about 1:1,000 and the mortality rate is less than 1:10,000. The most frequent complications are: hemorrhages due to injury of the larger vessels and burns in the intestine caused by the electric current. For this reason, conventional (:unipolar") electrocoagulation should be replaced by the so-called bipolar coagulation or other newer methods which avoid these complications. On the basis of the current literature, no definitive statements can be made regarding the reliability of the newer methods (silastic ring, plastic clips, thermocoagulation). An additional, although up until now purely hypothetic, advantage of the newer methods is the possibility of reversibility. With conventional electrocoagulation, the rate of reversilbility is very low. Additional alternatives are also culdotomy and minilaparotomy in the interval with the assistance of a uterus elevator. Both ways of access may be combined with various methods of sterilization. The pros and cons of the hysterectomy as a method of sterilization are still being discussed. Occasional late sequelae of sterilization such as menstrual disorders, pain and, particularly, problems related to sexual intercourse have only recently come to light. They have not yet been adequately investigated.

Electrocoagulation↗
PubMed1986

Drug interactions with oral contraceptives.

In the very rare cases where a pregnancy occurs during oral contraceptive use, the blame is usually laid against the patient for having forgotten to take the pill. Evidence has started to accumulate to suggest that neither the patient nor the pill is at fault in some contraceptive failures. It may be because the patient is taking other medicines and these may be preventing the pill from suppressing ovulation. Most drug interactions reducing or negating contraceptive activity are due to concomitant use of drugs having microsomal enzyme-inducing activity (e.g., some antibiotics, especially rifampicin, and anticonvulsants, including phenobarbital, phenytoin, and primidone. Other antibiotics (e.g., tetracycline) may also interact by interruption of the enterohepatic circulation of contraceptive steroids. Less well appreciated, oral contraceptive steroids may themselves modify the metabolism and pharmacological activity of various other drugs (e.g., anticoagulants, benzodiazepines, beta-blockers, caffeine, corticosteroids, and tricyclic antidepressants); in this respect the oral contraceptives are acting as enzyme inhibitors. Contraceptive steroids may also interact with drugs that cause enzyme inhibition and this delays the metabolism of the hormonal agents. Interactions of this type would be expected to potentiate the action of the contraceptive steroids. It is suggested that the effects of such interaction might be presented in terms of increased incidence of side effects, including water retention, diabetogenic effects, hypertension, and an increased risk of thromboembolic disorders. The spectrum of interactions with oral contraceptives is presented in three tables.

Binding, Competitive↗
PubMed1995

Socioeconomic variation in admission for diseases of female genital system and breast in a national cohort aged 15-43.

OBJECTIVE: To investigate socioeconomic variation among young women in the risk of hospital admission for diseases (including neoplasms) of the female genital system and breast and for the common surgical procedures of dilatation and curettage and hysterectomy. DESIGN: Large nationally representative cohort study with individual records of confirmed admissions to NHS and private hospitals since birth and data on occupational and educational experience. SETTING: England, Scotland, and Wales. PATIENTS: General population sample of 1628 women, 1549 of whom had a complete admissions record for the ages of 15-43 years. MAIN OUTCOME MEASURES: The percentage of women admitted for neoplasms or other diseases of the female genital system and breast or who had dilatation and curettage or hysterectomy between the ages of 15 and 43 years. RESULTS: By the age of 43, 35% of women had been admitted, 17% had undergone dilatation and curettage at least once, and 10% had had a hysterectomy. There were significant inverse educational gradients, the risk of admission increasing more than twofold between the most and least educated women. The differential risk was most striking for disorders of menstruation, in which only 1% of those with the highest educational qualifications and 19% of those with minimal qualifications had been admitted to hospital. There was a significant educational gradient in the hysterectomy rate (from 1% to 15%) and a twofold difference in the risk of dilatation and curettage. There were also significant gradients in risk of admission and of hysterectomy according to partner's social class. CONCLUSIONS: Socioeconomic variations in the risk of dilatation and curettage and of hysterectomy were large. Lessening the socioeconomic gradient in risks of admissions and surgery for diseases of the female genital system and breast, particularly for menstrual disorders, could have important resource implications.

Adolescent↗
PubMed1981

Late complications of sterilization according to method.

By using a patient questionnaire, we checked the effects of two tubal sterilization procedures (high-frequency [HF] and endocoagulation techniques) in relation to late complications. In the years following high-frequency sterilization, 23 women (8.9%) had hysterectomies; in the endocoagulation group only 9 patients (2.3%) underwent hysterectomy. Patients sterilized by the unipolar high-frequency technique required one to three curettages in 7.8% of cases, whereas only 2.1% of the endocoagulation group required this procedure. Seventy-nine patients in the high-frequency group (30.9%) exhibited menstrual disorders as compared to only 45 (11.7%) in the other group. The combination of menstrual irregularities and menopausal complaints was found in 7.4% of the HF group, while only 2.8% of the endocoagulation group experienced these problems. Menopausal complaints only, without menstrual disorders, occurred in 4.7% and 3.9% of the women, respectively. Eighty-five percent of 330 patients sterilized by the Semm endocoagulation technique had no menstrual complaints or menopausal symptoms; in the HF group this was the case for 160 women (62%). Our results demonstrate that late postoperative complications arise less often in patients sterilized by endocoagulation.

Adult↗
PubMed1982

Fertility after discontinuation of oral contraceptives.

Concern has been expressed regarding fertility following oral contraceptive (Pill) use. A review of the literature indicates that there is a slight delay in the return of fertility in Pill users but no permanent impairment results. A small proportion of women experience a prolonged period of amenorrhoea following cessation of combined oral contraception, but whether the Pill plays an aetiological role is doubtful since there appear to be no differences in endocrine profiles amongst women with amenorrhoea following Pill use and those with secondary amenorrhoea who have never used oral contraceptives. Factors which may predispose to amenorrhoea following Pill use are: late onset of menarche, previous oligomenorrhoea and low body weight. Following adequate investigation and treatment, fertility rates in women with the so-called post-Pill amenorrhoea syndrome return to normal. There is no evidence of any delay in the return of fertility in women who use the progestogen-only Pill.

Abortion, Incomplete↗
PubMed1995

The control of prostaglandin production by the endometrium in relation to luteolysis and menstruation.

Oestradiol acting on a progesterone-primed uterus stimulates prostaglandin (PG) F2 alpha synthesis by the endometrium. In some species (notably the sheep, cow and goat) oxytocin released from the ovary also forms part of the physiological stimulus for increased endometrial PGF2 alpha production. The corpus luteum contains high concentrations (> 1 microgram/g tissue) of this peptide in these species. The intracellular mechanisms by which these three hormones control endometrial PGF2 alpha synthesis and release are far from clear. Oxytocin stimulates the synthesis of inositol phosphates and diacylglycerol in the endometrium of some species, but whether this pathway is involved in endometrial PGF2 alpha synthesis is still open to question. There is evidence that increased endometrial PGF2 alpha synthesis is dependent upon increased endometrial protein synthesis but, apart from the recorded effects of steroid hormones on the concentrations of phospholipase A2, prostaglandin H synthase and oxytocin receptors, it is not known what other endometrial proteins are involved. Some disorders of menstruation are associated with abnormal PG production by the endometrium, but the reasons for this abnormality are not clear. During early pregnancy an increase in PGF2 alpha synthesis by the endometrium is prevented, except in the pig where the PGF2 alpha produced is directed from the venous drainage to the uterine lumen. In those species in which endometrial PGF2 alpha synthesis is dependent upon oxytocin secreted by the ovary, the conceptus secretes an interferon-tau (previously named trophoblast protein-1) which prevents oestradiol and oxytocin acting on a progesterone-primed uterus from stimulating endometrial PGF2 alpha synthesis. The identities of the factors produced by the conceptus which prevent endometrial PGF2 alpha synthesis during early pregnancy in other species are not known, although it is clear that they are not interferons.

Animals↗
PubMed1984

[Fertility disorders attributable to the use of diethylstilbestrol during intrauterine life].

A lot has been written about the abnormalities seen in children born to women treated with distilbene during pregnancy. The author reviews the current state of the certainties and the doubts. It seems that the increased number of miscarriages, extra-uterine pregnancies and perinatal deaths are probably due to the maternal treatment which is also responsible for semen abnormalities.

Abnormalities, Drug-Induced↗