Amenorrhea Treatment and Management

Amenorrhea Treatment and Management

 TREATMENT MODALITIES

  1. Cyclic progesterone (Provera 10 mg or Prometrium 400 mg, for a min­imum of 10 days for a minimum of every 2 months) helps protect against the development of endometrial hyperplasia and endometrial carcinoma.
    1. BCPs are useful when contraception is necessary but also protect against endometrial hyperplasia.
    2. BCPs improve hirsutism (reducing ovarian androgen production and increasing sex hormone—binding globulin that does reduce free androgen).
    3. This is a useful and convenient method of estrogen replacement therapy.
    4. Certain BCPs are not acceptable by athletic organization because of androgenic activity.
  2. Ovulation induction.
    1. Clomiphene citrate: There are increased incidence of symptomatic functional cysts, of multiply pregnancies, and a marginally increased risk of ovarian cancer.
    2. Pulsatile GnRH agonist therapy most closely mimics normal folli­cular development but is expensive and cumbersome.
    3. Gonadotrophin therapy is involved and expensive, with a higher risk of hyperstimulation, multiple pregnancy, and possibly ovarian carcinoma.
  3. Hysteroscope surgery often allows resumption of menses. Pregnancy rates depend on severity of the adhesions.
  4. Prolactin antagonists are treatment of choice in pituitary microadeno­mas, idiopathic hyperprolactinemia, and pretherapy for macroadenomas (which usually require surgery or targeted radiation).
  5. Estrogen therapy should be considered in all cases of hypoestrogenic states.

 

a.Tamoxifen can be used in patients with breast cancer.

b .Small doses of testosterone may improve quality of life and bone status.

  1. Egg and zygote donation can be considered if pregnancy is desired in the presence of nonfunctional ovaries.

 

 

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