Amenorrhea natural history, complications and prognosis: Difference between revisions
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{{Amenorrhea}} | {{Amenorrhea}} | ||
{{CMG}} | {{CMG}}; {{AE}}{{EG}} | ||
==Overview== | ==Overview== | ||
If left untreated, | If left untreated, patients with amenorrhea may progress to develop [[infertility]] and [[osteoporosis]]. Common complications of amenorrhea are based on underlying disorder that induce amenorrhea. [[Prognosis]] is generally excellent and the [[mortality rate]] of patients with amenorrhea is approximately less than 1%, generally in patients with [[brain]] lesions. | ||
==Natural History, Complications, and Prognosis== | ==Natural History, Complications, and Prognosis== | ||
===Natural History=== | ===Natural History=== | ||
*If left untreated, all patients of amenorrhea may progress to develop [[infertility]] and [[osteoporosis]]. | |||
*The majority of cases woth amenorrhea are result of four conditions, which include [[polycystic ovary syndrome]], [[hypothalamic]] amenorrhea, [[hyperprolactinemia]], and [[ovarian failure]]. | |||
*[[Polycystic ovary syndrome|Polycystic ovary syndrome (PCOS)]], if left untreated can lead to [[heart disease]] from elevated [[cholesterol]] and increased levels of [[androgens]]. Long periods of not having [[menstrual cycles]] leads to unopposed exposure of [[endometrium]] to [[estrogen]], can result in [[endometrial cancer]].<ref name="pmid26261426">{{cite journal |vauthors=Palomba S, Santagni S, Falbo A, La Sala GB |title=Complications and challenges associated with polycystic ovary syndrome: current perspectives |journal=Int J Womens Health |volume=7 |issue= |pages=745–63 |year=2015 |pmid=26261426 |pmc=4527566 |doi=10.2147/IJWH.S70314 |url=}}</ref> | |||
*In functional ([[hypothalamic]]) amenorrhea, the patient usually reports normal regular [[Menstrual cycles|cycles]] in the past, with sudden interruption of menstrual cycles for more than 3 months. There is almost always a history of [[weight loss]] (severe), excessive [[exercise]], or drastic [[emotional stress]] prior to cessation of [[menstruation]].<ref name="pmid25201001">Meczekalski B, Katulski K, Czyzyk A, Podfigurna-Stopa A, Maciejewska-Jeske M (2014) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=25201001 Functional hypothalamic amenorrhea and its influence on women's health.] ''J Endocrinol Invest'' 37 (11):1049-56. [http://dx.doi.org/10.1007/s40618-014-0169-3 DOI:10.1007/s40618-014-0169-3] PMID: [https://pubmed.gov/25201001 25201001]</ref> | |||
*[[Premature ovarian failure]] presents with menopause before the age of 40 and elevated levels of [[gonadotropins]]. In the age group of 41 to 44 years, it is called [[Menopause|pre-menopause]]. Patients of [[premature ovarian failure]] generally have a family history of [[ovarian failure]].<ref name="pmid10773392">{{cite journal |vauthors=Vegetti W, Marozzi A, Manfredini E, Testa G, Alagna F, Nicolosi A, Caliari I, Taborelli M, Tibiletti MG, Dalprà L, Crosignani PG |title=Premature ovarian failure |journal=Mol. Cell. Endocrinol. |volume=161 |issue=1-2 |pages=53–7 |year=2000 |pmid=10773392 |doi= |url=}}</ref> | |||
*Amenorrhea from [[hyperprolactinemia]] can be caused by [[Hyperprolactinemia|prolactin overproduction]] or [[dopamine]] suppression, and is mostly seen in middle aged women.<ref name="pmid2058949">{{cite journal |vauthors=Mattei AM, Severini V, Crosignani PG |title=Natural history of hyperprolactinemia |journal=Ann. N. Y. Acad. Sci. |volume=626 |issue= |pages=130–6 |year=1991 |pmid=2058949 |doi= |url=}}</ref> | |||
*If left untreated, all of | |||
*The majority of amenorrhea | |||
* | |||
*In functional ([[hypothalamic]]) amenorrhea, the patient usually reports normal regular [[Menstrual cycles|cycles]] in the past, | |||
*[[Premature ovarian failure]] | |||
*Amenorrhea | |||
===Complications=== | ===Complications=== | ||
*Common complications of amenorrhea are based on the | *Common complications of amenorrhea are based on the underlying disorder inducing amenorrhea. The majority of amenorrhea cases are caused by four conditions, which include [[polycystic ovary syndrome]], [[hypothalamic]] amenorrhea, [[hyperprolactinemia]], and [[ovarian failure]]. | ||
*Common complications of [[PCOS]] include: | *Common complications of amenorrhea from [[PCOS]] include: | ||
**[[Endometrial hyperplasia]]/[[Endometrial cancer]] | **[[Endometrial hyperplasia]]/[[Endometrial cancer]] | ||
**[[Insulin resistance]]/[[Diabetes mellitus type 2]] | **[[Insulin resistance]]/[[Diabetes mellitus type 2]] | ||
| Line 34: | Line 26: | ||
**[[Miscarriage]] | **[[Miscarriage]] | ||
**[[Infertility]] | **[[Infertility]] | ||
*[[Hyperprolactinemia]] leads to [[galactorrhea]], | *[[Hyperprolactinemia]] leads to [[galactorrhea]], [[decreased libido]], and [[pregnancy]] complications. In cases with [[prolactinoma]], massive enlargement of the [[tumor]] may affect [[Vision loss|vision]] and [[pituitary]] function. It may also cause [[osteopenia]] and [[osteoporosis]] in pre-[[menopausal]] women.<ref name="pmid10649820">{{cite journal |vauthors=Sanfilippo JS |title=Implications of not treating hyperprolactinemia |journal=J Reprod Med |volume=44 |issue=12 Suppl |pages=1111–5 |year=1999 |pmid=10649820 |doi= |url=}}</ref> | ||
*Common complications of [[premature ovarian failure]] | *Common complications of [[premature ovarian failure]] include [[infertility]], [[osteoporosis]], [[depression]]/[[anxiety]], [[cardiac disease]], and [[dementia]].<ref name="urlPremature ovarian failure - Symptoms and causes - Mayo Clinic">{{cite web |url=http://www.mayoclinic.org/diseases-conditions/premature-ovarian-failure/symptoms-causes/dxc-20255567 |title=Premature ovarian failure - Symptoms and causes - Mayo Clinic |format= |work= |accessdate=}}</ref> | ||
*Patients with [[hypothalamic]] (functional) amenorrhea experience various complications, such as [[infertility]], [[ | *Patients with [[hypothalamic]] (functional) amenorrhea experience various complications, such as [[infertility]], decrease in [[bone mineral density]] (BMD), increased risk for [[fracture]], along with [[cardiovascular]] and [[psychological]] complicatons.<ref name="pmid25201001" /> | ||
*The most important complication of [[premature ovarian failure]] is [[infertility]], that is preventable to some extent with appropriate therapies. [[Bone loss]] and [[psychiatric disorders]] are other complications.<ref name="pmid19196677">{{cite journal| author=Nelson LM| title=Clinical practice. Primary ovarian insufficiency. | journal=N Engl J Med | year= 2009 | volume= 360 | issue= 6 | pages= 606-14 | pmid=19196677 | doi=10.1056/NEJMcp0808697 | pmc=2762081 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19196677 }}</ref> | |||
===Prognosis=== | ===Prognosis=== | ||
*[[Prognosis]] is generally excellent and the [[mortality rate]] of patients with amenorrhea is approximately less than 1% | *[[Prognosis]] is generally excellent and the [[mortality rate]] of patients with amenorrhea is approximately less than 1%. | ||
*Among patients | *Among patients of [[androgen insensitivity syndrome]] there is an increased risk of [[testicular cancer]], and surveillance is needed appropriate intervals. | ||
*[[Prognosis]] of [[Polycystic ovary syndrome|polycystic ovary syndrome (PCOS)]] is generally good | *[[Prognosis]] of [[Polycystic ovary syndrome|polycystic ovary syndrome (PCOS)]] is generally good. Long term dietary management and [[exercise]] along with [[metformin]] therapy decreases the [[cardiovascular]] and [[pregnancy]] complications in the future.<ref name="pmid18007129">{{cite journal |vauthors=Hart R |title=Polycystic ovarian syndrome--prognosis and treatment outcomes |journal=Curr. Opin. Obstet. Gynecol. |volume=19 |issue=6 |pages=529–35 |year=2007 |pmid=18007129 |doi=10.1097/GCO.0b013e3282f10e22 |url=}}</ref> | ||
* | *[[Prognosis]] is excellent for hyperprolactinemia due to microprolactinoma. Depending on the size of the [[tumor]] and the extent of [[tumor]] resection, the rate of recurrence may range from 20% to 50%. The majority of recurrent prolactinomas develop within the first 5 years.<ref>http://www.niddk.nih.gov/health-information/health-topics/endocrine/prolactinoma/Pages/fact-sheet.aspx</ref> | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]
Overview
If left untreated, patients with amenorrhea may progress to develop infertility and osteoporosis. Common complications of amenorrhea are based on underlying disorder that induce amenorrhea. Prognosis is generally excellent and the mortality rate of patients with amenorrhea is approximately less than 1%, generally in patients with brain lesions.
Natural History, Complications, and Prognosis
Natural History
- If left untreated, all patients of amenorrhea may progress to develop infertility and osteoporosis.
- The majority of cases woth amenorrhea are result of four conditions, which include polycystic ovary syndrome, hypothalamic amenorrhea, hyperprolactinemia, and ovarian failure.
- Polycystic ovary syndrome (PCOS), if left untreated can lead to heart disease from elevated cholesterol and increased levels of androgens. Long periods of not having menstrual cycles leads to unopposed exposure of endometrium to estrogen, can result in endometrial cancer.[1]
- In functional (hypothalamic) amenorrhea, the patient usually reports normal regular cycles in the past, with sudden interruption of menstrual cycles for more than 3 months. There is almost always a history of weight loss (severe), excessive exercise, or drastic emotional stress prior to cessation of menstruation.[2]
- Premature ovarian failure presents with menopause before the age of 40 and elevated levels of gonadotropins. In the age group of 41 to 44 years, it is called pre-menopause. Patients of premature ovarian failure generally have a family history of ovarian failure.[3]
- Amenorrhea from hyperprolactinemia can be caused by prolactin overproduction or dopamine suppression, and is mostly seen in middle aged women.[4]
Complications
- Common complications of amenorrhea are based on the underlying disorder inducing amenorrhea. The majority of amenorrhea cases are caused by four conditions, which include polycystic ovary syndrome, hypothalamic amenorrhea, hyperprolactinemia, and ovarian failure.
- Common complications of amenorrhea from PCOS include:
- Hyperprolactinemia leads to galactorrhea, decreased libido, and pregnancy complications. In cases with prolactinoma, massive enlargement of the tumor may affect vision and pituitary function. It may also cause osteopenia and osteoporosis in pre-menopausal women.[5]
- Common complications of premature ovarian failure include infertility, osteoporosis, depression/anxiety, cardiac disease, and dementia.[6]
- Patients with hypothalamic (functional) amenorrhea experience various complications, such as infertility, decrease in bone mineral density (BMD), increased risk for fracture, along with cardiovascular and psychological complicatons.[2]
- The most important complication of premature ovarian failure is infertility, that is preventable to some extent with appropriate therapies. Bone loss and psychiatric disorders are other complications.[7]
Prognosis
- Prognosis is generally excellent and the mortality rate of patients with amenorrhea is approximately less than 1%.
- Among patients of androgen insensitivity syndrome there is an increased risk of testicular cancer, and surveillance is needed appropriate intervals.
- Prognosis of polycystic ovary syndrome (PCOS) is generally good. Long term dietary management and exercise along with metformin therapy decreases the cardiovascular and pregnancy complications in the future.[8]
- Prognosis is excellent for hyperprolactinemia due to microprolactinoma. Depending on the size of the tumor and the extent of tumor resection, the rate of recurrence may range from 20% to 50%. The majority of recurrent prolactinomas develop within the first 5 years.[9]
References
- ↑ Palomba S, Santagni S, Falbo A, La Sala GB (2015). "Complications and challenges associated with polycystic ovary syndrome: current perspectives". Int J Womens Health. 7: 745–63. doi:10.2147/IJWH.S70314. PMC 4527566. PMID 26261426.
- ↑ 2.0 2.1 Meczekalski B, Katulski K, Czyzyk A, Podfigurna-Stopa A, Maciejewska-Jeske M (2014) Functional hypothalamic amenorrhea and its influence on women's health. J Endocrinol Invest 37 (11):1049-56. DOI:10.1007/s40618-014-0169-3 PMID: 25201001
- ↑ Vegetti W, Marozzi A, Manfredini E, Testa G, Alagna F, Nicolosi A, Caliari I, Taborelli M, Tibiletti MG, Dalprà L, Crosignani PG (2000). "Premature ovarian failure". Mol. Cell. Endocrinol. 161 (1–2): 53–7. PMID 10773392.
- ↑ Mattei AM, Severini V, Crosignani PG (1991). "Natural history of hyperprolactinemia". Ann. N. Y. Acad. Sci. 626: 130–6. PMID 2058949.
- ↑ Sanfilippo JS (1999). "Implications of not treating hyperprolactinemia". J Reprod Med. 44 (12 Suppl): 1111–5. PMID 10649820.
- ↑ "Premature ovarian failure - Symptoms and causes - Mayo Clinic".
- ↑ Nelson LM (2009). "Clinical practice. Primary ovarian insufficiency". N Engl J Med. 360 (6): 606–14. doi:10.1056/NEJMcp0808697. PMC 2762081. PMID 19196677.
- ↑ Hart R (2007). "Polycystic ovarian syndrome--prognosis and treatment outcomes". Curr. Opin. Obstet. Gynecol. 19 (6): 529–35. doi:10.1097/GCO.0b013e3282f10e22. PMID 18007129.
- ↑ http://www.niddk.nih.gov/health-information/health-topics/endocrine/prolactinoma/Pages/fact-sheet.aspx