Menstrual disorders

Polycystic ovary syndrome is the most common endocrine disorder in women of reproductive age. Insulin resistance appears to be a critical factor in PCOS pathogenesis. Metformin, an insulin-sensitizing agent, is thus the preferred treatment option for PCOS.

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Mugwort (Artemisia vulgaris L.) is a familiar herbal medicine and also a daily vegetable. It is one of the ingredients in the famous remedy "Cao ích mẫu" specializing in menstrual disorders or the omelet with mugwort that helps save blood flow to the brain to treat headaches. In both traditional medicine and the new drugs, diseases are usually treated by mugwort as diabetes, epilepsy combination for psychoneurosis, depression, irritability, insomnia, anxiety, and stress. To demonstrate the medicinal uses, the chemical constituents of this herbal were continually studied.

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The rhizome of Angelica sinensis (Oliv.) Diels (Umbelliferae) is one of the most commonly used traditional drugs in China, indicated against anemia, menstrual disorders, amenorroehea and rheumatism. From the ethyl acetate extract of the roots of A. sinensis a stilbene, ferulic acid, coniferylferulate and decorticate have been isolated. Their structures were identified by MS and NMR spectroscopic methods.

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Refusal to maintain body weight at or above a minimally normal weight for age and height. (This includes a failure to achieve weight gain expected during a period of growth leading to an abnormally low body weight.) Intense fear of weight gain or becoming fat. Distortion of body image (e.g., feeling fat despite an objectively low weight or minimizing the seriousness of low weight). Amenorrhea. (This criterion is met if menstrual periods occur only following hormone—e.g., estrogen—administration.

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Polycystic Ovarian Syndrome: Treatment The major abnormality in patients with PCOS is the failure of regular, predictable ovulation. Thus, these patients are at risk for the development of dysfunctional bleeding and endometrial hyperplasia associated with unopposed estrogen exposure. Endometrial protection can be achieved with the use of oral contraceptives or progestins (medroxyprogesterone acetate, 5–10 mg, or prometrium, 200 mg daily for 10–14 days of each month).

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Acute Pelvic Pain: Treatment Treatment of acute pelvic pain depends on the suspected etiology but may require surgical or gynecologic intervention. Conservative management is an important consideration for ovarian cysts, if torsion is not suspected, to avoid unnecessary pelvic surgery and the subsequent risk of infertility due to adhesions. The majority of unruptured ectopic pregnancies are now treated with methotrexate, which is effective in 84–96% of cases. However, surgical treatment may be required.

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Harrison's Internal Medicine Chapter 51. Menstrual Disorders and Pelvic Pain Menstrual Disorders and Pelvic Pain: Introduction Menstrual dysfunction can signal an underlying abnormality that may have long-term health consequences. Although frequent or prolonged bleeding usually prompts a woman to seek medical attention, infrequent or absent bleeding may seem less troubling, and the patient may not bring it to the attention of the physician. Thus, a focused menstrual history is a critical part of every female patient encounter.

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Role of the hypothalamic-pituitary-gonadal axis in the etiology of amenorrhea. Gonadotropin-releasing hormone (GnRH) secretion from the hypothalamus stimulates follicle-stimulating hormone (FSH) and luteinizing hormone (LH) secretion from the pituitary to induce ovarian folliculogenesis and steroidogenesis. Ovarian secretion of estradiol and progesterone controls the shedding of the endometrium, resulting in menses and, in combination with the inhibins, provides feedback regulation of the hypothalamus and pituitary to control secretion of FSH and LH.

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Algorithm for evaluation of amenorrhea. β-hCG, human chorionic gonadotropin; PRL, prolactin; FSH, follicle-stimulating hormone; TSH, thyroidstimulating hormone. Hypogonadotropic Hypogonadism Low estrogen levels in combination with normal or low levels of LH and FSH are seen with anatomic, genetic, or functional abnormalities that interfere with hypothalamic GnRH secretion or normal pituitary responsiveness to GnRH. Although relatively uncommon, tumors and infiltrative diseases should be considered in the differential diagnosis of hypogonadotropic hypogonadism (Chap. 333).

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