Hypothalamus amenorrhea

O Unrecognized pregnancy remains the most common cause of amenorrhea, and a urine pregnancy test should be one of the first steps in the evaluation of this disorder. To help organize an approach to diagnosis and treatment, it is helpful to consider the organs involved in the menstrual cycle, which include the uterus, ovaries, anterior pituitary, and hypothalamus. 

The dopamine neurons that project from the hypothalamus to the anterior pituitary are known as the tuberoinfundibular dopamine pathway (Fig. 10—13). Normally, these neurons are active and inhibit prolactin release. In the postpartum state, however, their activity is decreased, and therefore prolactin levels can rise during breastfeeding, so that lactation will occur. If the functioning of tuberoinfundibular dopamine neurons is disrupted by lesions or drugs, prolactin levels can also rise. Elevated prolactin levels are associated with galactorrhea (breast secretions), amenorrhea,... 

Other effects Drowsiness occurs due to CNS depression, usually during the first 2 weeks of treatment. Confusion is sometimes encountered.The neuroleptics often produce dry mouth, urinary retention, constipation, and loss of accommodation. They block a-adrenergic receptors, resulting in lowered blood pressure and orthostatic hypotension. The neuroleptics depress the hypothalamus, causing amenorrhea, galactorrhea, infertility, and impotence. 

Many other factors or conditions wiU cause secondary amenorrhea. They include disorders of the ovary, uterus, pituitary, and hypothalamus, and drugs. 

Adolescents and women with primary or secondary amenorrhea, due to diet, excessive exercise, or hypothalamus-pituitary-ovarian axis disorders, have lower BMD than other age-equivalent individuals. 

The PA mifepristone also delays or inhibits ovulation, which may produce amenorrhea [48, 49]. Amenorrhea may be a consequence of an effect at the level of the ovary, pituitary or hypothalamus. The SPRM asoprisnil, in contrast, is not so effective in inhibiting ovulation [50]. The amenorrhea consequent to PAs and SPRMs occurs with levels of estradiol in the range of the early follicular phase of the menstrual cycle [48-50]. As a result ofthe antiproliferative effect and the amenorrhea, PAs and SPRMs have been advocated in the treatment of uterine myoma, endometriosis and dysfunctional uterine bleeding. 

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