Amenorrhea natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
If left untreated, all of patients with amenorrhea may progress to develop [[infertility]] and [[osteoporosis]]. Common complications of amenorrhea are based on the background [[disease]] that induced it. [[Prognosis]] is generally excellent and the [[mortality rate]] of patients with amenorrhea is approximately less than 1%, generally in [[brain]] lesions. | |||
==Natural History== | ==Natural History, Complications, and Prognosis== | ||
===Natural History=== | |||
==Complications== | *The symptoms of [[puberty]] usually develop in the second decade of life, 12-13 years of age and usually before 15 years of age. The main symptom of [[puberty]] in female gender is [[menarche]].<ref name="ChiavaroliDAdamo2011">{{cite journal|last1=Chiavaroli|first1=Valentina|last2=DAdamo|first2=Ebe|last3=Diesse|first3=Laura|last4=de|first4=Tommaso|last5=Chiarelli|first5=Francesco|last6=Moh|first6=Angelika|title=Primary and Secondary Amenorrhea|year=2011|doi=10.5772/17675}}</ref> | ||
* [[Infertility]] | *In primary amenorrhea: | ||
* [[ | **[[Menarche]] is not happened until 15 years of age, while other [[secondary sexual characteristics]] are already appeared. | ||
**[[Menarche]] is not happened after 5 years of [[thelarche]], if it is occurred before 10 years of age.<ref name="Herman-GiddensSlora1997">{{cite journal|last1=Herman-Giddens|first1=M. E.|last2=Slora|first2=E. J.|last3=Wasserman|first3=R. C.|last4=Bourdony|first4=C. J.|last5=Bhapkar|first5=M. V.|last6=Koch|first6=G. G.|last7=Hasemeier|first7=C. M.|title=Secondary Sexual Characteristics and Menses in Young Girls Seen in Office Practice: A Study from the Pediatric Research in Office Settings Network|journal=PEDIATRICS|volume=99|issue=4|year=1997|pages=505–512|issn=0031-4005|doi=10.1542/peds.99.4.505}}</ref> | |||
==Prognosis== | *In secondary amenorrhea: | ||
Among patients with androgen insensitivity syndrome there is an increased risk of [[testicular cancer]], and surveillance should be encouraged. | **[[Menstrual cycle]] is interrupted for at least 3 months, however was regular before.<ref name="ChiavaroliDAdamo2011" /> | ||
**[[Menstrual cycle]] is interrupted for at least 6 months, however was irregular before.<ref>{{cite book | last = Fritz | first = Marc | title = Clinical gynecologic endocrinology and infertility | publisher = Wolters Kluwer Health/Lippincott Williams & Wilkins | location = Philadelphia | year = 2011 | isbn = 978-0781779685 }}</ref> | |||
*If left untreated, all of patients with amenorrhea may progress to develop [[infertility]] and [[osteoporosis]]. | |||
*The majority of amenorrhea cases are caused by four conditions, include [[polycystic ovary syndrome]], [[hypothalamic]] amenorrhea, [[hyperprolactinemia]], and [[ovarian failure]]. | |||
*In the case of amenorrhea secondary to [[Asherman syndrome|Asherman's syndrome]], past medical history shows [[uterine]] surgery and also [[scarring]]. | |||
*About [[Polycystic ovary syndrome|polycystic ovary syndrome (PCOS)]], if left untreated can develop [[heart disease]] due to 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, when suddenly the [[Menstrual cycles|cycles]] are interrupted for more than 3 months. There is almost always a history of [[weight loss]] (severe), excessive [[exercise]], or drastic [[emotional stress]] prior to [[menstruation]] stop.<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]] is [[menstrual cycle]] pause, along with elevated levels of [[gonadotropins]], occurred before age 40. In period of 41 to 44 years, it is called pre-[[menopause]]. It is generally related to family history of [[ovarian failure]] in relative females.<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 due to [[hyperprolactinemia]], caused by [[prolactin]] overproduction or [[dopamine]] suppression, mostly occurred in middle aged women. Idiopathic [[hyperprolactinemia]] is elevated serum [[prolactin]] level without any [[brain]] lesion or other pathologies. There is a little chance of [[pituitary tumor]] in 2-10 years of the [[disease]].<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> | |||
===Complications=== | |||
*Common complications of amenorrhea are based on the background [[disease]] that induced it. | |||
*Common complications of [[PCOS]] include: | |||
**[[Endometrial hyperplasia]]/[[Endometrial cancer]] | |||
**[[Insulin resistance]]/[[Diabetes mellitus type 2]] | |||
**[[High blood pressure]] | |||
**[[Dyslipidemia]] | |||
**[[Cardiovascular disease]] | |||
**[[Stroke]] | |||
**[[Miscarriage]] | |||
**[[Infertility]] | |||
*[[Hyperprolactinemia]] leads to [[galactorrhea]], decreasing [[libido]], and [[pregnancy]] complications. In case of [[prolactin]]-producing [[pituitary adenoma]], massive enlargement of the [[tumor]] may influence on [[Vision loss|vision]] and [[pituitary]] function. It can 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]] are including [[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]], [[Bone mineral density|bone mineral density (BMD)]] decrease, [[fracture]] risk increase, along with [[cardiovascular]] and [[psychological]] problems.<ref name="pmid25201001" /> | |||
===Prognosis=== | |||
*[[Prognosis]] is generally excellent and the [[mortality rate]] of patients with amenorrhea is approximately less than 1%, generally in [[brain]] lesions. | |||
*Among patients with [[androgen insensitivity syndrome]] there is an increased risk of [[testicular cancer]], and surveillance should be encouraged. | |||
*[[Prognosis]] of [[Polycystic ovary syndrome|polycystic ovary syndrome (PCOS)]] is generally good, long term [[diet]] and [[exercise]] along with [[metformin]] therapy decrease the [[cardiovascular]] and [[pregnancy]] problems 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> | |||
*The most important complication of [[premature ovarian failure]] is [[infertility]], that is preventable to some extend with appropriate therapies. [[Bone loss]] and [[Mental disorder|mental problems]] 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> | |||
*Long term (7 years) [[prognosis]] of [[hyperprolactinemia]] due to [[Microadenoma of the pituitary|microadenomas]] showed 90-95% stability or gradual decrease of [[prolactin]] serum level. Whereas, one third of patients with idiopathic [[hyperprolactinemia]] are cured without [[therapy]], two third if basal [[prolactin]] < 40 ng/mL. 40% of [[Macroadenoma of the pituitary|macroadenomas]] relapse during 5 years after [[surgery]].<ref name="urlHyperprolactinemia Follow-up: Further Outpatient Care, Complications, Prognosis">{{cite web |url=http://emedicine.medscape.com/article/121784-followup?pa=F4SeDbXyg7Us96IIpQ1rX45tZ67G2vFYwa9FwTj7DHRubNjXSWpONBuSt9eO7oY6LCEJNCrbkqLWYvqLrhntWA%3D%3D#e3 |title=Hyperprolactinemia Follow-up: Further Outpatient Care, Complications, Prognosis |format= |work= |accessdate=}}</ref> | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
If left untreated, all of patients with amenorrhea may progress to develop infertility and osteoporosis. Common complications of amenorrhea are based on the background disease that induced it. Prognosis is generally excellent and the mortality rate of patients with amenorrhea is approximately less than 1%, generally in brain lesions.
Natural History, Complications, and Prognosis
Natural History
- The symptoms of puberty usually develop in the second decade of life, 12-13 years of age and usually before 15 years of age. The main symptom of puberty in female gender is menarche.[1]
- In primary amenorrhea:
- Menarche is not happened until 15 years of age, while other secondary sexual characteristics are already appeared.
- Menarche is not happened after 5 years of thelarche, if it is occurred before 10 years of age.[2]
- In secondary amenorrhea:
- Menstrual cycle is interrupted for at least 3 months, however was regular before.[1]
- Menstrual cycle is interrupted for at least 6 months, however was irregular before.[3]
- If left untreated, all of patients with amenorrhea may progress to develop infertility and osteoporosis.
- The majority of amenorrhea cases are caused by four conditions, include polycystic ovary syndrome, hypothalamic amenorrhea, hyperprolactinemia, and ovarian failure.
- In the case of amenorrhea secondary to Asherman's syndrome, past medical history shows uterine surgery and also scarring.
- About polycystic ovary syndrome (PCOS), if left untreated can develop heart disease due to 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.[4]
- In functional (hypothalamic) amenorrhea, the patient usually reports normal regular cycles in the past, when suddenly the cycles are interrupted for more than 3 months. There is almost always a history of weight loss (severe), excessive exercise, or drastic emotional stress prior to menstruation stop.[5]
- Premature ovarian failure is menstrual cycle pause, along with elevated levels of gonadotropins, occurred before age 40. In period of 41 to 44 years, it is called pre-menopause. It is generally related to family history of ovarian failure in relative females.[6]
- Amenorrhea due to hyperprolactinemia, caused by prolactin overproduction or dopamine suppression, mostly occurred in middle aged women. Idiopathic hyperprolactinemia is elevated serum prolactin level without any brain lesion or other pathologies. There is a little chance of pituitary tumor in 2-10 years of the disease.[7]
Complications
- Common complications of amenorrhea are based on the background disease that induced it.
- Common complications of PCOS include:
- Hyperprolactinemia leads to galactorrhea, decreasing libido, and pregnancy complications. In case of prolactin-producing pituitary adenoma, massive enlargement of the tumor may influence on vision and pituitary function. It can also cause osteopenia and osteoporosis in pre-menopausal women.[8]
- Common complications of premature ovarian failure are including infertility, osteoporosis, depression/anxiety, cardiac disease, and dementia.[9]
- Patients with hypothalamic (functional) amenorrhea experience various complications, such as infertility, bone mineral density (BMD) decrease, fracture risk increase, along with cardiovascular and psychological problems.[5]
Prognosis
- Prognosis is generally excellent and the mortality rate of patients with amenorrhea is approximately less than 1%, generally in brain lesions.
- Among patients with androgen insensitivity syndrome there is an increased risk of testicular cancer, and surveillance should be encouraged.
- Prognosis of polycystic ovary syndrome (PCOS) is generally good, long term diet and exercise along with metformin therapy decrease the cardiovascular and pregnancy problems in the future.[10]
- The most important complication of premature ovarian failure is infertility, that is preventable to some extend with appropriate therapies. Bone loss and mental problems are other complications.[11]
- Long term (7 years) prognosis of hyperprolactinemia due to microadenomas showed 90-95% stability or gradual decrease of prolactin serum level. Whereas, one third of patients with idiopathic hyperprolactinemia are cured without therapy, two third if basal prolactin < 40 ng/mL. 40% of macroadenomas relapse during 5 years after surgery.[12]
References
- ↑ 1.0 1.1 Chiavaroli, Valentina; DAdamo, Ebe; Diesse, Laura; de, Tommaso; Chiarelli, Francesco; Moh, Angelika (2011). "Primary and Secondary Amenorrhea". doi:10.5772/17675.
- ↑ Herman-Giddens, M. E.; Slora, E. J.; Wasserman, R. C.; Bourdony, C. J.; Bhapkar, M. V.; Koch, G. G.; Hasemeier, C. M. (1997). "Secondary Sexual Characteristics and Menses in Young Girls Seen in Office Practice: A Study from the Pediatric Research in Office Settings Network". PEDIATRICS. 99 (4): 505–512. doi:10.1542/peds.99.4.505. ISSN 0031-4005.
- ↑ Fritz, Marc (2011). Clinical gynecologic endocrinology and infertility. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. ISBN 978-0781779685.
- ↑ 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.
- ↑ 5.0 5.1 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".
- ↑ 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.
- ↑ Nelson LM (2009). "Clinical practice. Primary ovarian insufficiency". N Engl J Med. 360 (6): 606–14. doi:10.1056/NEJMcp0808697. PMC 2762081. PMID 19196677.
- ↑ "Hyperprolactinemia Follow-up: Further Outpatient Care, Complications, Prognosis".