Anovulation and Amenorrhea 4

Question 1

What is the treatment for anovulatory women with PCOS?

Answer 1

• 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

Question 2

What is the treatment for hypogonadotropic hypogonadism?

Answer 2

• 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

Question 3

What is the treatment for patients with POF?

Answer 3

• Hormone replacement therapy to prevent osteoporosis
• Want to reduce risk of CV disease
• only effective fertility treatment is oocyte donation

Question 4

What is the method of inducing ovulation and treating hypogonadism in women with hyperprolactinemia?

Answer 4

Cabergoline - dopamine agonist, 0.5 to 1 mg 2x/week