Approach to the Patient With New-Onset Secondary Amenorrhea: Is This Primary Ovarian Insufficiency?
| Autor: | Richard J. Santen, JoAnn V. Pinkerton, Susan R. Davis, Anne Gompel, Mary Ann Lumsden, Cynthia A. Stuenkel |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Adult
medicine.medical_specialty Hormone Replacement Therapy medicine.drug_class Endocrinology Diabetes and Metabolism media_common.quotation_subject Clinical Biochemistry Population Physiology Fertility Ovary Primary Ovarian Insufficiency Biochemistry Diagnosis Differential Endocrinology Internal medicine medicine Humans Medical History Taking education Amenorrhea Pathological Menstrual Cycle media_common education.field_of_study Pregnancy business.industry Biochemistry (medical) medicine.disease medicine.anatomical_structure Estrogen Etiology Female medicine.symptom business |
| Zdroj: | The Journal of Clinical Endocrinology & Metabolism. 107:825-835 |
| ISSN: | 1945-7197 0021-972X |
| DOI: | 10.1210/clinem/dgab766 |
| Popis: | Menstrual cyclicity is a marker of health for reproductively mature women. Absent menses, or amenorrhea, is often the initial sign of pregnancy—an indication that the system is functioning appropriately and capable of generating the intended evolutionary outcome. Perturbations of menstrual regularity in the absence of pregnancy provide a marker for physiological or pathological disruption of this well-orchestrated process. New-onset amenorrhea with duration of 3 to 6 months should be promptly evaluated. Secondary amenorrhea can reflect structural or functional disturbances occurring from higher centers in the hypothalamus to the pituitary, the ovary, and finally, the uterus. Amenorrhea can also be a manifestation of systemic disorders resulting in compensatory inhibition of reproduction. Identifying the point of the breakdown is essential to restoring reproductive homeostasis to maintain future fertility and reestablish reproductive hormonal integrity. Among the most challenging disorders contributing to secondary amenorrhea is primary ovarian insufficiency (POI). This diagnosis stems from a number of possible etiologies, including autoimmune, genetic, metabolic, toxic, iatrogenic, and idiopathic, each with associated conditions and attendant medical concerns. The dual assaults of unanticipated compromised fertility concurrently with depletion of the normal reproductive hormonal milieu yield multiple management challenges. Fertility restoration is an area of active research, while optimal management of estrogen deficiency symptoms and the anticipated preventive benefits of hormone replacement for bone, cardiovascular, and neurocognitive health remain understudied. The state of the evidence for an optimal, individualized, clinical management approach to women with POI is discussed along with priorities for additional research in this population. |
| Databáze: | OpenAIRE |
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