Hormone and endocrine disorders

This chapter covers various hormonal and endocrine disorders that can occur in women. It starts with the definition, assessment, diagnosis, causes and treatment for both primary and secondary amenorrhoea. It then covers polycystic ovarian syndrome, including diagnosis, treatment, and long-term complications. Then it moves onto hirsutism, from a general overview, to investigations, treatment, and medication that may be prescribed in secondary care. Finally, premature ovarian syndrome (POF) is defined, and causes and treatments are suggested.

Amenorrhea

Amenorrhoea is defined as absence of menstruation in women of reproductive age. Primary amenorrhoea is a failure to start menstruation by the age of 13 years without secondary sexual characteristics or by the age of 15 years with normal secondary sexual characteristics. Secondary amenorrhoea is the absence of menstruation for 6 months in a woman with normal prior menstruation. Secondary amenorrhea is more common type, with a prevalence of between 3 and 4%. This compares with a prevalence of 0.3% for those with primary amenorrhea.

Amenorrhoea with XY karyotype postbone marrow transplant

A 17-year-old girl presented with secondary amenorrhoea. She developed normal age-appropriate secondary sexual characteristics and attained menarche at the age of 13 years. One year following her menarche, she was diagnosed with acute myeloid leukaemia and was treated with chemotherapy, total body radiation and bone marrow transplant with complete remission. The matched donor was her elder male sibling. Her evaluation for secondary amenorrhoea included full hormonal analysis and pelvic ultrasound scan. These suggested hypergonadotrophic hypogonadism with a normal uterus and ovaries. Peripheral leucocyte karyotype as part of routine hypogonadism workup was found to be 46 XY. The differential diagnosis of Swyer syndrome, which entails surgical removal of gonads due to the high risk of gonadoblastoma, was raised initially before reviewing the laboratory results of previous chromosomal analysis. Considering her medical history, the amenorrhoea was finally attributed to ovarian insufficiency due to chemotherapy and radiotherapy. The 46 XY karyotyping could be explained by the bone marrow transplant received from her donor brother. Hypogonadism causing amenorrhoea is commonly encountered after chemoradiotherapy. Pretreatment and post-treatment chromosomal analysis is essential in such cases. Karyotyping could be misleading especially if the patient suffered from graft-versus-host reaction post gender mismatched bone marrow transplant.

Secondary vaginal atresia following caesarean section: an unreported entity

Postpartum genital tract adhesions are infrequent and exact incidence is not reported. Severe dystocia, obstructed labour and frequent pelvic examinations have been proposed as possible causes of vaginal adhesion following vaginal delivery. Atresia/adhesions of vagina following caesarean section is very rare. Here, we report a rare case of 21-year-old P1L1 woman presenting with secondary amenorrhoea associated with cyclical abdominal pain following caesarean section. Per speculum examination showed a blind vagina with no communication with the upper one-third. We created a neovagina after adhesiolysis. We hope to increase the awareness of the obstetricians around the globe about postpartum genital tract adhesion, which may even occur as a rare secondary complication of caesarean section. We also wish to bring to the light of obstetricians that numerous pelvic examinations or difficult vaginal delivery may lead to genital tract trauma, and thus, must be minimised in an attempt to prevent postpartum genital tract adhesions.

Side effects and discontinuation rate of depot medroxyprogesterone acetate in a tertiary hospital, southern Nigeria

Background: Depot medroxyprogesterone acetate (DMPA) also known as depo provera is a highly effective, safe and long-lasting reversible contraceptive with side effects that may cause discontinuation amongst acceptors. Objective was to determine the prevalence rate, side effects, discontinuation rate and indications for discontinuation of DMPA at Rivers State University Teaching Hospital (RSUTH), Port Harcourt.Methods: This was a retrospective study of 874 clients attending family planning clinic at the RSUTH from 1st January, 2015 to 31st December, 2019. Their records were retrieved from the clinic and reviewed. Data was extracted, coded and analyzed using the statistical package for social sciences (SPSS) IBM version 25.0 (Armonk, NY).Results: One hundred and one clients accepted DMPA out of 874 acceptors of contraceptives within the study period giving a prevalence rate of 11.6%. The modal age group was 25-29 years accounting for 31 (30.7%). Age range was 19-47 years and the modal parity was para 2. Majority of the clients had formal education, 100 (99%), married, 94 (93.1%) and multipara 61 (60.4%). The discontinuation rate was 32.7% and the commonest reasons for discontinuation were secondary amenorrhoea and irregular vaginal bleeding with each contributing 24.2%.Conclusions: The prevalence and discontinuation rates of Depo provera were low. Secondary amenorrhoea and irregular vaginal bleeding were the commonest side effects and reasons for discontinuation.

HUBUNGAN PEMAKAIAN KONTRASEPSI SUNTIK DENGAN KEJADIAN AMENOREA DIWILAYAH KERJA PUSKESMAS ATARI JAYA KECAMATAN LALEMBUU KABUPATEN KONAWE SELATAN TAHUN 2015

Amenorrhoea is no occurrence of menstruation for 3 months or more in women who have experienced menstrual cycles. Some cases of amenorrhea can be found in injectable contraceptive acceptors. This is confirmed by the data from Southeast Sulawesi province that there are 284,784 and 201,627 (70.8%) among them experiencing amenorrhea. Objective: To find out whether there is a relationship between injectable contraception and the incidence of amenorrhea in the work area of Atari Jaya Health Center, Lalembuu District, South Konawe Regency in 2015. Research methods: Analytical research with adesign crossstudy. The sample in this study amounted to 92 injectable contraceptive acceptors. This research uses accidental sampling technique. Data analysis included univariate and bivariate analysis using the SPSS (Chi Square test) program at the level of confidence α = 0.05. Results: Amenorrhoea is a complaint that is often felt in injectable contraceptive acceptors. Of the 92 injectable contraceptive acceptors who suffered secondary amenorrhoea there were 59 (64.1%) acceptors while 33 (35.9%) acceptors did not suffer from secondary amenorrhoea. This shows that the value of ρ = 0,000 is smaller than the value of α = 0.05. Then there is the relationship of injectable contraception with the incidence of amenorrhea. Conclusion: There is a correlation between injectable contraceptive use and the incidence of amenorrhea in the work area of Atari Jaya Community Health Center, Lalembuu Subdistrict, South Konawe Regency in 2015.

Amenorrhoea

Amenorrhoea is the absence of menstruation in a female patient of reproductive age. Patients with amenorrhoea may be concerned about puberty and fertility depending on the age of presentation. It is important for clinicians to consider the underlying causes and appropriately assess, investigate and counsel each patient. Approximately 0.3% of females experience primary amenorrhoea, and 3–4% of females at reproductive age experience secondary amenorrhoea. This article aims to outline the differential diagnoses for both primary and secondary amenorrhoea and to consider investigation and management in primary care, including indications for referral to secondary care.