Anovulation and Amenorrhea 4 Flashcards
Describe effective therapeutic approaches to the infertile couple.
1
Q
What is the treatment for anovulatory women with PCOS?
A
-
OCP or cyclic progestin to produce regular endometrial shedding
- Will prevent irregular bleeding and minimize the risk of endometrial hyperplasia
- If progestin is used, should be given for 12-14 days every month
- Ideal therapy for anovulation in obese patients is weight loss
- 5-10% will lead to regular menses or pregnancy in 80% of obese women iwth PCOS
-
Clomiphene citrate is another option
- graduated regimen of 50-150 mg daily for 5 days
- ovulation induced in 80% of women
- fecundity of 0.22, similar to ferile women
- Metformin and aromatase inhibitors or gonadotropins can be considered if other efforts to induce ovulation is not successful
2
Q
What is the treatment for hypogonadotropic hypogonadism?
A
- Psychological counseling
- Modest wieght gain (1lb/week)
- Reduction in exercise intensity
- Estrogen replacement does not improve bone mineral content in women with eating disorders and amenorrhea
- Daily injection of gonadotropins for about 10-14 days (LH and FSH activity) require to induce ovulation
3
Q
What is the treatment for patients with POF?
A
- Hormone replacement therapy to prevent osteoporosis
- Want to reduce risk of CV disease
- only effective fertility treatment is oocyte donation
4
Q
What is the method of inducing ovulation and treating hypogonadism in women with hyperprolactinemia?
A
Cabergoline - dopamine agonist, 0.5 to 1 mg 2x/week