Overweight patient with hyperinsulinism and oligo-amenorreha seeking pregnancy
OLIGO AND AMENORRHOEA
Hormonal contraception is an effective birth control strategy when used appropriately. However, there are several non-contraceptive benefits associated with the use of these preparations. Women using oral contraceptives experience lighter more predictable menses and report less cramping. Extended and continuous regimens allow for delay or elimination of withdrawal bleeding. In addition, cyclic or continuous regimens are used to effectively manage dysmenorrhea, menorrhagia, and endometriosis. Women with polycystic ovary syndrome or idiopathic hirsutism experience a reduction in androgenic symptoms with the pill. Long-term use of combined oral contraceptives (COCs) is associated with a reduction in the incidence of endometrial cancer and ovarian cancer. There is conflicting evidence that COCs promote bone accretion in adolescents with hypothalamic hypogonadism or anorexia nervosa. We will review the current concepts surrounding the non-contraceptive benefits of combined oral contraceptives, and discuss when and how these therapeutics may be utilized.
Abstract: A 35 year old patient attended the clinic after one year of primary infertility and 9 years secondary amenorrhoea. Her BMI was 21.9 kg/m2. Transvaginal scan examination showed a small uterus with 1.7 mm thick endometrium. The left ovary was quiescent and measured 2.9 x 1.2 x 2.1 cm. 3D images manipulation showed a large (96.9 cm3) solid mass attached to the right ovary. Follicle stimulating hormone (FSH) level was 3.8 IU/L, oestradiol was 57 pmol/l and testosterone was 0.9 nmol/L. She had normal thyroid indices, serum prolactin, 17-hydroxyprogesterone and cortisol levels. Inhibin B and luteinising hormone (LH) blood levels were high at 408 pg/ml and 19.5 IU/L respectively. The mass was shelled laparoscopically off the right ovary, and proved histologically to be a parasitic leiomyoma. She resumed regular menstruation one month after surgery and conceived in her fourth cycle. To the best of our knowledge, this is the first case to be reported relating high inhibin B and luteinising hormone blood levels to an ovarian leiomyoma.
Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is characterized by Mullerian duct aplasia in an XX individual with female phenotype presenting primary amenorrhea at adolescence. Multiple abnormalities may be associated to the MRKH syndrome. Genetic investigations focused on the genes of AMH and its receptor, on WT1, PAX2, CFTR, Hox genes have been unproductive. more
Objective: The aim of the study was to investigate the anthropometric and endocrine characteristics of subjects with amenorrhoea related to eating disorders after weight recovery, in order to identify the factors connected with the resumption of menses. more