menotropins and Weight-Loss

The most important causes of the functional hypothalamic amenorrhea (FHA), that are psychological stress, physical stress and weight loss, are associated with a decrease of the frequency of the LH secretory pulses and with a state of hypercortisolism. The slowing down of the LH pulse frequency is difficult to demonstrate in clinical practice. The classical symptoms of FHA which are low gonadotropin levels, and hypogonadism are not very specific. The diagnosis of FHA is therefore one of exclusion. Recent physiopathological studies have individualised new symptoms that are hypercortisolism, hypoprolactinaemia and an important increase in the night serum levels of melatonine, all of which could help to confirm the diagnosis. FHA is relatively frequent and its treatment with pulsatile GnRH administration or naltrexone is very successful.

Topics: Amenorrhea; Chorionic Gonadotropin; Clomiphene; Diagnosis, Differential; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Hypothalamic Diseases; Luteinizing Hormone; Menotropins; Stress, Psychological; Weight Loss

The amenorrhea associated with bilateral polycystic ovaries, described by Stein and Leventhal, actually represents a syndrome involving various organs and systems. Clinically, this symptom complex commonly presents as menstrual disturbances, infertility, excessive body weight, and hirsutism. An understanding of the pathophysiology that underlies these symptoms provides a logical basis for evaluation and treatment of the syndrome. The diagnostic approach may involve biochemical determinations (baseline, stimulated, and suppressed) and radiologic testing. Therapy is directed at chronic anovulation, the hyperandrogenism responsible for hirsutism and acne, and the prophylaxis against endometrial and breast carcinomas. Ovulation can be induced with various agents, many of which have a risk of ovarian hyperstimulation in the PCOD patient. The use of GnRH agonists with HMG or FSH for ovulation induction will probably increase in the future. Although classic wedge resection has little place in modern management of PCOD, the recent laparoscopic ovarian cautery remains largely unstudied with respect to long-term postoperative plasma androgen levels and pelvic adhesions. It is too premature to evaluate this new surgical therapy. Hirsutism is effectively treated with estrogen-progestin combinations, medroxyprogesterone acetate, androgen receptor blockers (spironolactone, cimetidine, cyproterone acetate, and cyproheptadine), and glucocorticoids. To date, the available GnRH agonists have not been found selective enough to be used in the treatment of hirsutism, owing to possible long-term complications. Most medical approaches should include electrolysis for permanent hair removal. At present, gynecologic surgery seems to have little place in the management of hirsutism.

Topics: Clomiphene; Diagnosis, Differential; Female; Follicle Stimulating Hormone; Glucocorticoids; Gonadotropin-Releasing Hormone; Hirsutism; Humans; Menotropins; Menstruation Disturbances; Ovulation Induction; Polycystic Ovary Syndrome; Weight Loss

We describe successful ovulation induction with low-dose hCG administration in addition to hMG in a patient with refractory hypothalamic amenorrhea. A 24-year-old woman with weight loss-related amenorrhea underwent ovulation induction and intracytoplasmic sperm injection (ICSI). Administration of exogenous gonadotropins was ineffective in ovulation induction. Supplementation with low-dose hCG in order to increase luteinizing hormone (LH) activity in the late follicular phase produced late folliculogenesis and steroidogenesis, and ovulation was then successfully induced. This report reacknowledges the critical role that LH plays cooperatively with follicle-stimulating hormone in both folliculogenesis and steroidogenesis.

Topics: Amenorrhea; Chorionic Gonadotropin; Dose-Response Relationship, Drug; Drug Combinations; Female; Humans; Hypothalamic Diseases; Infertility, Female; Menotropins; Pregnancy; Treatment Outcome; Weight Loss; Young Adult