Anti Androgens

Spironolactone is an anti-mineralocorticoid agent that also acts as an anti-androgen. It is a potassium sparing diuretic that in high doses (100-200 mg day) demonstrates significant anti-androgenic properties. Spironolactone interferes with testosterone biosynthesis by reducing 17-hydroxylase activity and thus lowers plasma testosterone. It also inhibits dihydrotestosterone's binding to the androgen receptor. It is not FDA-approved for treatment of androgenic symptoms but in many studies has...

Differential Diagnosis

A comprehensive history and physical examination are indicated to rule out other possible causes of the emotional and physical symptoms of PMS. The differential diagnosis includes premenstrual molimina, hypothyroidism, perimenopause and major mood or anxiety disorders. Most ovulatory women experience some physical changes (e.g., breast tenderness, bloating, and food cravings) during the luteal phase. If these physical symptoms do not interfere with normal life functions, the term molimina can...

Pharmacotherapy

Pharmacotherapy can supplement dietary changes and exercise to promote weight loss. Pharmacotherapy can be utilized after 6 months of combined intervention of diet and increased physical activity in patients with a BMI > 30 with no concomitant obesity-related risk factors for diseases, and in patients with a BMI > 27 with concomitant obesity-related risk factors or diseases. The amount of extra weight loss attributed to these agents is less than 5 kilograms at 1 year evaluation. Thus, the...

Suggested Reading

N Engl J Med 2002 346(8) 591-602, This is an excellent review article of the treatment of obesity . 2. Mokdad AH, Ford ES, Bowman BA et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 2003 289(1) 76-9. 3. North American Association for the Study of Obesity and the National Heart, Lung, and Blood Institute. The practical guide Identification, evaluation, and treatment of overweight and obesity in adults. Bethesda, MD...

Endocrine Evaluation

Peripheral Follicles Polycystic Ovary

As PCOS is diagnosed after exclusion of other endocrine disorders, a work-up to assess for these other conditions is indicated. Table 5.2 summarizes the primary endocrine evaluation. Key to the differential diagnosis is to rule out late onset congenital adrenal hyperplasia due to 21-hydroxylase deficiency. This disorder mimics PCOS as it also presents at menarche and is associated with hyperandrogenism. Unlike PCOS the increased androgens in congenital adrenal hyperplasia are primarily from...

Vivian Lewis MD

Department of Obstetrics and (gynecology Division of Reproductive Endocrinology University of Rochester School of Medicine and Dentistry VADEMECUM Reproductive Endocrinology and Infertility LANDES BIOSCIENCE Austin, Texas U.S.A. Copyright 2007 Landes Bioscience All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without permission in...

Diagnosis

Diagnosis of endometriosis is often problematic. Although patients classically present with pelvic pain, dysmenorrhea, dyspareunia, pelvic mass and infertility, there are also many patients who are asymptomatic. It has been found that 25 of all women who experience pelvic pain and 40-50 of infertile women have endometriosis. Most symptoms that women experience are a result of local infiltration of endometriosis into the pelvis pelvic pain, dyschezia (painful defecation), abdominal bloating,...

Alternative Medicine and Female Infertility

Hey-Joo Kang, Pak Chung and Raymond Chang Acupuncture Acupuncture is a vital therapeutic modality in traditional Chinese Medicine and its use can be traced back for centuries. The theory behind acupuncture is based upon the premise that there are patterns of energy flow, or Qi, through the body, which are essential for health. When a disease state exists, the flow of Qi is interrupted and its correction will assist in the healing process. Acupuncture can correct imbalances of flow at...

Your Environment Your Fertility Is There a Link

Fertility, the ability of people to produce offspring, was a concept formerly applied only to the female. Demographers traditionally defined the fertility rate as the average number of live-born children per woman of reproductive age. However, fertility is one of the few measures that reflect the joint health of two individuals, and we have only recently begun to appreciate the extent to which fertility depends on the health and environment of both the male and female partner, as well as the...

Progestin Only Pills

The progestin only pill (POP), also commonly called the mini-pill, contains only progestin and is taken daily without any pill-free days. The mechanism of action is identical to the progestin-related mechanisms for COCs. The primary mechanism is thickening of the cervical mucus (this action is short lived, and requires punctual dosing to be effective). Progestin use also causes decreased tubal and endometrial motility and thin, atrophic endometrium. Only about 50 of women will have ovarian...

Miscellaneous

Pelvic lacerations trauma Intrauterine device Intravaginal foreign body Drug-related (including hormonally active agents) Modified from Phipps WR. Abnormal vaginal bleeding. In Leppert PC, Peipert JF, eds. Primary Care for Women, 2nd Ed. Philadelph excluded with reasonable certainty prior to treatment. Accordingly, the diagnosis of either anovulatory or ovulatory DUB is one of exclusion. The pathophysiology and optimal treatment of anovulatory DUB are best understood by comparison to the...

Insulin Sensitizing Agents

Given the prevalence of insulin resistance seen in PCOS, a number of insulin-sensitizing agents have been studied in the treatment of symptoms. Currently metformin, a biguanide, and pioglitazone and rosiglitazone, thiazolidinediones, are available clinically, and all have been studied in PCOS. The single most common agent for use in PCOS is metformin. Metformin appears to work by reducing hepatic glucose output thereby reducing the demand for insulin. A meta-analysis of thirteen studies of...

Anxiolytics

Alprazolam, a triazolobenzodiazepine anxiolytic agent, has also been studied in the treatment of premenstrual syndrome. Of five randomized controlled trials, four found alprazolam to be more effective than placebo. In positive studies, alprazolam was particularly effective for management of premenstrual anxiety. Clinicians should remain cautious when prescribing alprazolam given its risk of tolerance and dependence. Buspirone, a nonbenzodiazepine anxiolytic agent, has not been found to be...

Assisted Reproductive Technology

Tiffany Von Wald and Kim Thornton Introduction Assisted reproductive technology (ART) is by definition any treatment or procedure that includes the handling of oocytes and sperm or embryos outside the body for the purpose of establishing a pregnancy. In vitro fertilization (IVF) is the most common ART procedure. The first IVF baby was conceived in 1978 (Louise Brown) in Lancashire, England. IVF has been used in the United States since 1981. In vitro fertilization (IVF) A process including...

An Overview of Female Infertility

Torrente and Valerie Montgomery Rice Overview According to the 1995 National Survey of Family Growth, the percentage of women reporting some form of fecundity impairment rose from 8 in 1988 to 10 in 1995 which some believe is related in part to a trend toward delayed child-bearing. Numerous observational studies have demonstrated that 80-90 of couples that have unprotected intercourse for 12 months will conceive. Thus, the accepted definition of an infertile couple is the failure to...

Surgical Treatment of Female Infertility

Posterior Cul Sac

Mohammed Al-Sunaidi and Togas Tulandi Introduction Due to widespread availability of assisted reproductive technologies, the need for reproductive surgery in infertile women has declined in recent decades. However, surgery still has a place in the management of infertile women. For example, young women with pelvic adhesions or blocked fallopian tubes that impair their fertility may benefit from early surgical intervention. On the other hand, women over the age of 35 with a long history of...

Amenorrhea

Infertile Discharge

Michael Wittenberger and Alicia Armstrong Introduction Amenorrhea is a common gynecologic complaint that generates consternation in patients and clinicians alike. Patients are concerned because cyclic menstrual periods are considered to be a sign of health, and conversely, the absence of menstrual periods are a sign of disease. Additionally, the broad differential diagnosis, perceived complexity of the work up and the ramifications of the diagnoses often intimidate clinicians. The purpose of...

Male Infertility

Stephanya Shear and Jeanne O'Brien Epidemiology Male infertility is the sole cause of 20 of couple infertility and contributes an additional 30 as a cause for combined couple infertility. Most men seeking infertility counseling and evaluation are referred through gynecologists or primary care physicians caring for the female partner. Thus, specialized knowledge or training about infertility is very important as is the ability to work closely with reproductive endocrinologists and gynecologic...

Females Males

Syndrome Albright

Maximal growth velocity Maximal growth velocity In boys, two Sertoli cell proteins, inhibin B and antimullerian hormone (AMH) mullerian inhibiting substance (MIS), are produced in the early neonatal period. Inhibin B (human males have minimal inhibin A) increases soon after birth and peaks at 4-12 months of age, declines to low levels by ages 3-9, and then increases again with the onset of puberty (at lower levels than the neonate). AMH MIS is evident in the first month of life and peaks about...

The Menstrual Cycle

Once a month the human endometrium exhibits a well-orchestrated, repeating cycle of proliferation, differentiation, death and renewal. Remarkably, the same cells programmed to slough within two weeks in the absence of a blastocyst are also able to nurture a gestation, if present, for 40 weeks. For implantation to occur, synchronization between the age of the embryo and the developmental stage of the en-dometrium is an absolute requirement. When functioning properly, the...

Reproductive Endocrinology Diagnostic Imaging

Hsg Patient Images

Fujimoto Introduction The last few decades have witnessed rapid advances in diagnostic and therapeutic options in modern medicine. While the field of reproductive endocrinology has stayed away from many diagnostic modalities using ionizing radiation, the field has benefited from advances in imaging modalities such as ultrasound and magnetic resonance. In this chapter, we will review the general principles of these techniques and offer examples from reproductive...

Categories of Weight Loss Drugs

These agents decrease food intake by reducing appetite or increasing satiety. The mechanisms of action are to increase secretion of dopamine, norepinephrine, or serotonin into the synaptic neural cleft, to inhibit the reuptake of these neurotrans-mitters into the neuron or a combination of the two effects. There are three classes of anorexiant drugs, and all affect neurotransmitters in the brain. 1. Affect catecholamines dopamine and norepinephrine. These noradrenergic agents are useful for...

Ovulation Induction

Ovulation Stimulation

Bradshaw Introduction Approximately 25 of infertility can be attributed to ovulatory disorders. The goal of ovulation induction is to restore fecundity by restoring regular, ovulatory cycles. Ovulation induction may also be used for controlled ovarian hyperstimulation COH for treatment of other causes of infertility such as mild moderate en-dometriosis, unexplained infertility, and for assisted reproductive techniques such as in vitro fertilization IVF . When used...