AMENORRHEA

AMENORRHEA

Library of Congress Cataloging-in-Publication Data

CONTENTS

INTRODUCTION

SECTION I: GENERAL

Chapter 1: AMENORRHEA: INTRODUCTION ,DEFINITIONS AND CLASSIFICATION

ABSTRACT

INTRODUCTION

EPIDEMIOLOGY

PATHOPHYSIOLOGY

DEFINITIONS AND CLASSIFICATION

Physiologic Amenorrhea

Pathologic Amenorrhea

Primary Amenorrhea

Secondary Amenorrhea

CONCLUSION

REFERENCES

Chapter 2: MENSTRUAL PHYSIOLOGY AND ABNORMALITIES

ABSTRACT

INTRODUCTION

NORMAL MENSTRUAL CYCLE

Ovarian Cycle

Uterine Cycle

Menstrual Cycle Length

Fertile Period

Monitoring Ovulation Time

MENSTRUAL ABNORMALITIES

Dysmenorrhoea

Abnormal Uterine Bleeding

The PALM-COEIN Classification System

Disturbances of Regularity

Disturbances in Frequency

Disturbances of Heaviness of Flow

Disturbance of the Duration of Flow

Bleeding Outside Reproductive Age

Causes of Abnormal Uterine Bleeding

Notation of AUB

CONCLUSION

REFERENCES

Chapter 3: EVALUATION OF AMENORRHEA

ABSTRACT

INTRODUCTION

MEDICAL HISTORY

PHYSICAL EXAMINATION

INVESTIGATION

CONCLUSION

REFERENCES

Chapter 4: PHARMACOTHERAPY OF AMENORRHEA

ABSTRACT

INTRODUCTION

DRUG TREATMENT

Selective Serotonin Reuptake Inhibitors

Metformin

GnRH Analogues

Dopamine Agonists

Leptin Analogue

REFERENCES

SECTION II: PRIMARY AMENORRHEA

Chapter 5: MANAGEMENT OF AMENORRHEA IN ADOLESCENTS

ABSTRACT

INTRODUCTION

PUBERTY

PATHOGENESIS

CAUSES OF AMENORRHEA

Anatomic Defects of the Outflow Tract

Pituitary Amenorrhea

Hypothalamic Amenorrhea

Receptor and Enzyme Defects

MANAGEMENT

Physical Examination

Laboratory Investigations

Treatment

CONCLUSION

REFERENCES

Chapter 6: TESTICULAR FEMINIZATION SYNDROME

ABSTRACT

INTRODUCTION

PATHOGENESIS

Androgen Receptor Gene and the Androgen Receptor

Androgens and Mechanism of Action

Fetal Sex Development

Molecular Pathogenesis of CAIS

EPIDEMIOLOGY

CLINICAL PRESENTATION

DIAGNOSIS

History and Physical Examination

Hormonal Assay

Genetic Analysis

Androgen Binding Assay

Radiological Imaging

Testicular Biopsy

Laparoscopy or Laparotomy

MANAGEMENT

Genetic Counselling

Psychological Counselling and Support

Hormone Replacement Therapy

Gonadectomy

Vaginoplasty

Management of Infertility

Prevention

PROGNOSIS

CONCLUSION

REFERENCES

Chapter 7: ANDROGEN INSENSITIVITY SYNDROME

ABSTRACT

INTRODUCTION

Complete Androgen Insensitivity Syndrome (CAIS)

Partial Androgen Insensitivity Syndrome (PAIS)

Mild Androgen Insensitivity Syndrome (MAIS)

PATHOGENESIS

MANAGEMENT

CONCLUSION

REFERENCES

Chapter 8: GONADAL DYSGENESIS

ABSTRACT

INTRODUCTION

PATHOGENESIS

Complete Gonadal Dysgenesis

Partial Gonadal Dysgenesis

CLINICAL FEATURES

DIAGNOSIS AND TREATMENT

CONCLUSION

REFERENCES

Chapter 9: CRYPTOMENORRHEA

ABSTRACT

INTRODUCTION

EPIDEMIOLOGY

PATHOGENESIS

AETIOLOGY AND CLASSIFICATION

CLINICAL FEATURES

DIFFERENTIAL DIAGNOSIS

MANAGEMENT

Diagnosis

Treatment

Counselling

Surgical Management

1. Imperforate Hymen

2. Transverse Vaginal Septum

3. Müllerian Agenesis

4. Labial Adhesion

5. Vaginal Atresia or Agenesis

CONCLUSION

REFERENCES

Chapter 10: KALLMANN’S SYNDROME

ABSTRACT

INTRODUCTION

EPIDEMIOLOGY

PATHOGENESIS

CLINICAL PRESENTATION

DIFFERENTIAL DIAGNOSIS

MANAGEMENT

Diagnosis

Treatment

Pre-Conceptional Counselling

PROGNOSIS

PREVENTION OF KALLMANN SYNDROME

CONCLUSION

REFERENCES

SECTION III: SECONDARY AMENORRHEA

Chapter 11: ASHERMAN’S SYNDROME

ABSTRACT

INTRODUCTION

EPIDEMIOLOGY

Pathogenesis

CLASSIFICATION SYSTEMS

Toeff and Ballas Classification

March, Israel and March 1978 classification

Valle and Sciarra’s 1988 Classification [21]

American Society for Reproductive Medicine Classification 1988

The European Society for Hysteroscopy Classification

Donnez and Nisolle 1994 Classification [24]

CLINICAL PRESENTATION

INVESTIGATION

Clinical Evaluation

Laboratory and Clinical Investigation

DIFFERENTIAL DIAGNOSIS

TREATMENT

Adhesiolysis

Hysterotomy

Dilatation and Curettage

Hysteroscopy

Prevention of Adhesion Recurrence

Restoration of Normal Endometrium

POST-OPERATIVE ASSESSMENT

PROGNOSIS

PREVENTION

CONCLUSION

REFERENCES

Chapter 12: SHEEHAN’S SYNDROME

SUMMARY

INTRODUCTION

EPIDEMIOLOGY

AETIOPATHOGENESIS

CLINICAL PRESENTATION

HAEMATOLOGICAL ABNORMALITIES

DIAGNOSIS

DIFFERENTIAL DIAGNOSIS

TREATMENT

CONCLUSION

REFERENCES

Chapter 13: HYPERPROLACTINAEMIA

ABSTRACT

INTRODUCTION

BIOLOGICAL ACTION OF PROLACTIN

PATHOGENESIS

EPIDEMIOLOGY

CLINICAL FEATURES

INVESTIGATION

Laboratory Investigations

Imaging Studies

TREATMENT

Group 1

Group 2

Group 3

CONCLUSION

REFERENCES

Chapter 14: PREMATURE OVARIAN FAILURE

ABSTRACT

INTRODUCTION

PATHOGENESIS

Familial and Genetic Causes

Auto Immune Causes

Iatrogenic Causes

Infectious Causes

Environmental Toxins

Idiopathic

CLINICAL EVALUATION

Investigation

MANAGEMENT

Lifestyle Modification

Hormone Replacement Therapy (HRT)

Contraception

Non-Hormonal Treatments

Fertility Preservation

Psychological and Psychosexual Support

CONCLUSION

REFERENCES

Chapter 15: FEMALE ATHLETE TRIAD

ABSTRACT

INTRODUCTION

EPIDEMIOLOGY

PATHOGENESIS

Low Energy

Menstrual Dysfunction

Altered Bone Mineral Density

Other Dysfunction in FAT

RISK FACTORS

EVALUATION

COMPLICATIONS

LABORATORY INVESTIGATION

TREATMENT

Prevention

Psychological Therapy

Nutritional Therapy

Exercise Modification

Drug Therapy

CONCLUSION

REFERENCES

Chapter 16: MENSTRUAL ABNORMALITIES IN ANOREXIA NERVOSA

ABSTRACT

INTRODUCTION

CLINICAL PRESENTATION

PATHOGENESIS

The Role of Body Weight

The Role of Fat Mass

The Role of Leptin

The Role of Cortisol/Adrenal Function

The Role of Disordered Eating and Over-Exercise

The Role of Psychopathology

INVESTIGATIONS

Hormone Tests and Pelvic Ultrasound

Bone Mineral Density Evaluation

MANAGEMENT

Determination of an Individual Healthy Body Weight

PROGNOSIS

CONCLUSION

REFERENCES

Chapter 17: MENSTRUAL IRREGULARITIES IN OBESITY

ABSTRACT

INTRODUCTION

EPIDEMIOLOGY AND PREDISPOSING FACTORS OF OBESITY

OBESITY AND REPRODUCTIVE HEALTH OF WOMEN

PATHOPHYSIOLOGY

Obesity and Menstrual Abnormality

Anovulation and Menstrual Disturbances

Menstrual Cycle Related Changes in Appetite

MANAGEMENT

Diagnosis

Diet

Medications

Weight Loss Surgery [11]

CONCLUSION

REFERENCES

Chapter 18: POLYCYSTIC OVARIAN DISEASE

ABSTRACT

INTRODUCTION

EPIDEMIOLOGY

AETIOPATHOGENESIS

Leptin

DIAGNOSTIC CRITERIA

CLINICAL FEATURES

Ferriman-Gallwey Hirsutism

LABORATORY FEATURES

Thyroid Function Test

Prolactin Levels

LEVELS OF TESTOSTERONE

DEHYDROEPIANDROSTERONE SULPHATE (DHEAS)

LEVELS OF LH AND FSH

LEVELS OF INSULIN

ULTRASOUND

ENDOMETRIAL BIOPSY

DIFFERENTIAL DIAGNOSIS

1. Congenital Adrenal Hyperplasia

2. Cushing’s Syndrome

3. Androgen Secreting Ovarian Tumour

4. Androgen Secreting Adrenal Tumour

5. Hypothyriodism

6. Hyperthyriodism

7. Hyperprolactinaemia

8. Premature Ovarian Failure

9. Hypogonadotrophic Hypogonadism

SPECIFIC INTERVENTIONS

1. No Intervention

2. Exercise and Weight Loss

3. Management of Oligomenorrhoea and Anovulation Using CombinationOral Contraceptive Pills

4. Cyclic Progestins

5. The Use of Insulin Sensitizing Agents

6. Intervention for Hirsutism

TREATMENT OF ACNE

TREATMENT OF ACANTHOSIS NIGRICANS

SURGICAL MEANS OF TREATING ANOVULATION

REFERENCES

LIST OF CONTRIBUTORS

INDEX

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