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.
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===
*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>
*If left untreated, all patients of amenorrhea may progress to develop [[infertility]] and [[osteoporosis]].  
*In primary amenorrhea:
*The majority of cases woth amenorrhea are result of four conditions, which include [[polycystic ovary syndrome]], [[hypothalamic]] amenorrhea, [[hyperprolactinemia]], and [[ovarian failure]].
**Absence of [[Menarche]] until 15 years of age, while other [[secondary sexual characteristics]] have already appeared.
**Absence of [[Menarche]] after 5 years of [[thelarche]], if [[thelarche]] 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>
*In secondary amenorrhea:
**[[Menstrual cycle]] is interrupted for at least 3 months, however [[Menstrual cycle|menstrual cycles]] were regular before.<ref name="ChiavaroliDAdamo2011" />
**[[Menstrual cycle]] is interrupted for at least 6 months, however [[Menstrual cycle|menstrual cycles]] were 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, which include [[polycystic ovary syndrome]], [[hypothalamic]] amenorrhea, [[hyperprolactinemia]], and [[ovarian failure]].
*In the case of amenorrhea secondary to [[Asherman syndrome|Asherman's syndrome]], patients usually have a past medical history of [[uterine]] surgery and [[scarring]].
*[[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>
*[[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, 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 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>
*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]] is [[menstrual cycle]] pause, along with elevated levels of [[gonadotropins]], seen before age 40. In age group 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>
*[[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 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>
*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>
===Complications===
===Complications===
*Common complications of amenorrhea are based on the background [[disease]] that induced it.
*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]], decreasing [[libido]], and [[pregnancy]] complications. In case of [[prolactin]]-producing [[pituitary adenoma]], massive enlargement of the [[tumor]] may influence the [[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>
*[[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]] 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>
*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]], decrease in [[Bone mineral density|bone mineral density (BMD)]], increased risk for [[fracture]] along with [[cardiovascular]] and [[psychological]] problems.<ref name="pmid25201001" />
*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 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>
*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 with [[androgen insensitivity syndrome]] there is an increased risk of [[testicular cancer]], and surveillance should be done at appropriate intervals.
*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, 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>
*[[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>
*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>
*[[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}}

Latest revision as of 13:37, 3 November 2017

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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

Complications

Prognosis

References

  1. ↑ 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. ↑ 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
  3. ↑ 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.
  4. ↑ Mattei AM, Severini V, Crosignani PG (1991). "Natural history of hyperprolactinemia". Ann. N. Y. Acad. Sci. 626: 130–6. PMID 2058949.
  5. ↑ Sanfilippo JS (1999). "Implications of not treating hyperprolactinemia". J Reprod Med. 44 (12 Suppl): 1111–5. PMID 10649820.
  6. ↑ "Premature ovarian failure - Symptoms and causes - Mayo Clinic".
  7. ↑ Nelson LM (2009). "Clinical practice. Primary ovarian insufficiency". N Engl J Med. 360 (6): 606–14. doi:10.1056/NEJMcp0808697. PMC 2762081. PMID 19196677.
  8. ↑ 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.
  9. ↑ http://www.niddk.nih.gov/health-information/health-topics/endocrine/prolactinoma/Pages/fact-sheet.aspx

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