Anovulation, chronic

In the adolescent population, specific blood dyscrasias should be treated. In addition, acute, severe bleeding may be managed with high-dose estrogen. Low-dose OCs (less than or equal to 35 meg ethinyl estradiol) are the treatment of choice in adolescents with chronic anovulation.11... 

Medical treatment of endometriosis has focused on the hormonal alteration of the menstrual cycle in an attempt to produce a pseudopregnancy, pseudomenopause, or chronic anovulation (Olive et al. 2001). 

Yen SSC. Chronic anovulation caused by peripheral endocrine disorders. In Yen SSC, Jaffe RB, eds. Reproductive endocrinology. Philadelphia WB Saunders Co, 1992 576-630. 

PCOS occurs in about 5% to 10% of premenopausal women and is thought to be caused by a hypothalamic disorder. PCOS is clinically defined by hyperandro-genism with chronic anovulation in women without underlying disease of the adrenal or pituitary glands. This syndrome is characterized by infertility, hirsutism, obesity (in approximately half of those affected), and various menstrual disturbances ranging from amenorrhea to irregular... 

Reproductive Effects. In samples from more than 200 men, no correlation between seminal fluid selenium and sperm count or mobility was detected. No significant increase in spontaneous abortions was reported among women chronically exposed to drinking water containing excessive amounts of selenium. Oral or injection treatment of rats with sodium selenate or selenite (at doses at least 8 times greater than those normally supplied by an adequate diet) has been shown to increase the number of abnormal sperm, produce testicular hypertrophy, or degeneration and atrophy in males, and to affect the estrous cycle in females. The animals in these studies were not mated, so it is not clear if fertility was affected. A small increase in the number of abnormal length estrous cycles was observed in mice exposed to selenium. Disturbances in the menstrual cycle (anovulation, short luteal and follicular phases) were also observed in monkeys treated orally with L-selenomethionine. Selenium deficiency has also been reported to cause decreased sperm production and motility in rats. The relevance of these reproductive effects of selenium in laboratory animals to potential reproductive effects in humans is not known. 

L12. Lim, V. S., Hentiguez, C., Sievertsen, G., Frohman, L. A., et ai. Ovarian function in chronic renal failure Evidence suggesting hypothalamic anovulation. Ann. Intern. Med. 93, 21-27... 

Medroxyprogesterone acetate (Fig. 46.13), administered by injection (Depo-Provera), orally, or delivered via lUD, effectively suppresses the HPO axis, induces anovulation, and reduces serum estrogen levels (83). This prevents menstruation and endometrial implant growth. As a result, endometriosis-related pain is minimized in approximately 90% of the patients. Drug therapy selection should reflect the fact that pharmacological therapy is likely to be required on a chronic basis. The progestins are fairly well tolerated and relatively inexpensive, but they are not without adverse effects. 

Polycystic ovary syndrome (PCOS) is a complex en-docrinologic disorder characterized by inappropriate gonadotropin secretion that results in chronic anovulation [60]. It affects as many as 5%-10% of women of reproductive age, and is found in 50% in women with infertility problems [61]. 

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