Ovarian failure, amenorrhea

The effects on fertility of inhibitors of topoisomerases 1 and 11 have not yet been fully elucidated. However, ovarian failure, amenorrhea, anovulatory cycles, and hypome-norrhea have been described in women receiving etoposide (150). 

Premature ovarian failure—Amenorrhea, sex-steroid deficiency, and infertility in women younger than 40 years of age. 

Therapeutic modalities for amenorrhea are targeted at restoring the normal menstrual cycle. The goals of treatment are to preserve bone density, prevent bone loss, and restore ovulation, thus improving fertility as desired. Amenorrhea resulting from conditions contributing to hypoestrogenism also may affect quality of life via the induction of hot flashes (premature ovarian failure), dyspareunia, and in prepubertal females, lack of secondary sexual characteristics and absence of menarche. 

Premature ovarian failure is a condition characterized by sex-steroid deficiency, amenorrhea, and infertility in women younger than 40 years of age. It affects 1% of women. Premature ovarian failure is associated with a significantly higher risk for osteoporosis and cardiovascular disease and increased mortality. 

A 26-year-old woman with chronic myeloid leukemia developed busulfan-induced ovarian failure, with amenorrhea, climacteric symptoms, raised plasma concentrations of luteinizing and follicle-stimulating... 

In autoimmune diseases cyclophosphamide can cause menstrual disorders (oligomenorrhea or sustained amenorrhea) and ultimately sterihty or premature menopause. This has been particularly exemplified in lupus erythematosus, and several studies have shown a high prevalence of menstrual disorders or premature ovarian failure in cyclophosphamide-treated patients, or a significantly higher incidence of both complications compared with other immunosuppressive regimens or healthy controls (31-33). 

Susceptibihty factors have been investigated in a large retrospective study of 274 patients aged under 45 years, of whom 70 had received cyclophosphamide, 84 azathiopr-ine but not cyclophosphamide, and 88 either no drug or hydroxychloroquine alone (35). The overall incidence of ovarian failure, defined as sustained amenorrhea for at least 12 months and documented by reduced estradiol concentrations, was 26, 1, and 0% respectively. The mean delay to onset of the first missed menses was 4.4 months. A higher age at the start of treatment and cumulative dose were independent risk factors for cyclophosphamide-induced ovarian failure. The incidences were 14, 28, and 50% in patients aged under 30 years, 30-39 years, and over 40 years respectively, and 4, 26, 31, 70%... 

The risk of ovarian failure and infertility has been studied in 84 women with an underlying inflammatory disease receiving intravenous cyclophosphamide (65). The incidence of sustained amenorrhea was 22% and was independent of the underlying inflammatory disease. After treatment with cyclophosphamide following bone marrow transplantation, ovarian function can occasionally recover, resulting in a successful pregnancy up to 7 years after treatment (66). No specific factors correlated with recovery of normal ovarian function. However, recovery was rare if the patient had undergone concurrent total body irradiation (67). 

Disorders of the ovary such as premature ovarian failure (POP) and loss of ovarian function can cause amenorrhea. POF has been defined as failure of ovarian estrogen production occurring in a hypergonadotropic state at any age between menarche and age If the patient is... 

Premature ovarian failure is a condition characterized by sex-steroid deficiency, amenorrhea, and infertility in women younger than 40 years of age. At one time, premature ovarian failure was considered irreversible and was described as premature menopause. Premature ovarian failure is not an early natural menopause. Normal menopause results from ovarian follicle depletion, whereas premature ovarian failure is characterized by intermittent ovarian function in one-half of affected women.These women produce estrogen intermittently and may ovulate despite the presence of high gonadotropin concentrations. Pregnancies have occurred in 5% to 10% of women after the diagnosis of premature ovarian failure—even in women with no follicles observed on ovarian biopsy. 

Premature ovarian failure may occur on the basis of ovarian follicle dysfunction or ovarian follicle depletion and may present as either primary amenorrhea (absence of menses in a girl who has reached the age of 16) or secondary amenorrhea (cessation of menses in a woman previously menstruating for 6 months or more). 

Premature ovarian failure is defined by the presence of at least 4 months of amenorrhea and at least two serum FSH concentrations measuring greater than 40 lU/L (obtained at least 1 month apart) in women younger than 40 years of age. A complete history should be taken regarding other factors that can affect ovarian function such as prior ovarian surgery, chemotherapy, radiation, and autoimmune disorders. In patients with primary amenorrhea, particular attention should be paid to breast and pubic hair development according to... 

Hyperprolactinemia Hypothalamic amenorrhea Premature ovarian failure... 

Vascular anastomotic communications between the uterine and ovarian arteries provide a route by which embolization materials can affect the ovarian blood supply and ovarian function, either permanently or temporarily [71], One case report describes embolic microspheres found within the ovarian arterial vasculature of a pathological specimen following uneventful UAE [66]. Unintentional embolization of the ovarian arteries is theorized to cause ovarian failure. However, the incidence of ovarian failure post UAE is no different to hysterectomy [100]. In fact, it is not clear whether UAE has any effect on ovarian function at all. There are studies that support its lack of effect [3,17,99,100] and a few case reports that document transient or permanent amenorrhea [92,98]. 

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