Efectos de la menopausia temprana en la función pulmonar: revisión integrativa / Effects of early menopause on lung function: an integrative review

La menopausia provoca cambios hormonales y alteraciones sistémicas. La menopausia normal sucede entre los 45-55 años y la menopausia temprana (MT) se desarrolla antes de los 45 años. Revisar la evidencia que señala posibles asociaciones entre la MT y la función pulmonar, analizando específicamente aquellos componentes que se encuentran alterados. Se eligieron estudios transversales y revisiones sistemáticas, en inglés, portugués y español. La búsqueda se realizó de marzo a noviembre de2022, en PubMed y Scopus, aemás de búsquedas manuales. La calidad metodológica fue analizada utilizando la escala Strengthening the Reporting of Observational Studies in Epidemiology para los estudios observacionales, y el Ameasurement Tool to Assess Systematic Review para las revisiones. Se encontraron 698 estudios, 12 seleccionados para calificación metodológica, cinco excluidos. Al final del análisis metodológico, se obtuvieron seis estudios transversales y una revisión sistemática, llevados a cabo en Reino Unido, Europa y Asia. Hay una tendencia para asociación de la MT a un patrón ventilatorio restrictivo. Sin embargo la evidencia sigue siendo escasa y se sugiere la realización de nuevos estudios.

Menopause causes hormonal changes and systemic alterations. Normal menopause is when this event occurs between the ages of 45 and 55, and early menopause (EM) when it develops earlier than 45 years. To review the evidence that indicates possible associations between EM and lung function, specifically analyzing those components that are altered. Cross-sectional and systematic reviews studies, published from 2000-2022, in English, Portuguese and Spanish were selected from March to November 2022, in PubMed and Scopus and through manual searches. Methodological quality was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology scale for observational studies, and the Measurement Tool to Assess Systematic Review for reviews. 698 studies were found, 12 were selected for methodological quality review and 5 were excluded. At the end of methodological analysis, 6 cross-sectional studies and 1 systematic review were obtained, carried out in United Kingdom, Europe and Asia. There is a tendency for EM to be associated with restrictive ventilatory pattern. However, the evidence is scarce and further studies are suggested.

A experiência da menopausa precoce em mulheres com câncer de mama com idade inferior a 45 anos / The experience of premature menopause induced by breast cancer treatment in women under 45 years old

O aumento da incidência de câncer de mama em mulheres jovens, com menos de 45 anos, aliado à cronicidade da doença tem despertado a necessidade de melhor compreender as repercussões do tratamento com o intuito de construir um cuidado em saúde que atenda as especificidades das mulheres jovens com câncer de mama. A menopausa precoce está entre os aspectos com importante impacto à vida das mulheres jovens. Desta forma, o presente estudo teve por objetivo compreender o processo de luto decorrente da menopausa precoce induzida pelo tratamento do câncer de mama em mulheres com menos de 45 anos. Para atingir o objetivo proposto realizamos um estudo qualitativo, a partir do método clínico-qualitativo e da análise de conteúdo. Empregamos a entrevista aberta e o Procedimento de Desenhos-Estórias (D-E) como principais instrumentos de coleta de dados, que foram complementados com questionário de dados sociodemográficos e dados clínicos. Os dados foram analisados a partir da compreensão do luto como uma Transição Psicossocial e de teorias psicodinâmicas que permitiram aprofundar a compreensão dos aspectos subjetivos do processo de luto decorrente da menopausa precoce induzida pelo tratamento. A análise dos dados permitiu identificar cinco categorias: Corpo devastado e o ataque ao suporte identitário: "Eu mesma não me reconheço"; Necessidade de se familiarizar com o novo corpo: "É normal sentir isso?"; De corpo inteiro: "Meu corpo inteiro, eu notei que ele mudou"; O sofrimento associado à possibilidade da infertilidade: "É o meu Tendão de Aquiles"; e "Como fogo e gelo": Vicissitudes do desejo sexual criando desencontros na relação com o parceiro íntimo. Foi possível identificar diversas perdas simbólicas decorrentes da experiência da menopausa precoce que foram significativas para as mulheres jovens em tratamento. O conjunto de mudanças corporais fragiliza a base identitária do ser mulher jovem e antecipa algumas vivências ligadas ao envelhecimento. Observou-se que alguns lutos puderam ser ressignificados, enquanto outros apresentaram características de luto complicado, por não terem sido integrados a uma nova identidade. Os aspectos psicodinâmicos identificados no contexto do tratamento do câncer de mama e da consequente menopausa precoce, evidenciaram uma regressão das necessidades básicas, como necessidade de proteção e cuidado, bem como, sentimentos de culpa, ambivalência, medo da perda, medo da morte e desproteção. Tendências construtivas como a busca pela autonomia, pelo desenvolvimento pessoal e o desejo de recuperar a saúde também foram observados. Esperamos que o conhecimento produzido contribua para a melhor compreensão dos lutos simbólicos decorrentes da experiência da menopausa precoce induzida pelo tratamento do câncer de mama, para que o cuidado integral à mulher jovem com câncer de mama considere as repercussões da menopausa à saúde e vida dessas mulheres auxiliando na elaboração de tais lutos

The increased incidence of breast cancer in young women under 45 years of age and the chronicity of the disease has aroused the need to better understand the repercussions of treatment in order to offer a health care that meets the specificities of young women with breast cancer. Premature menopause is among the aspects with an important impact on young women's lives. Thus, the presente study aimed to understand the process of mourning resulting from premature menopause induced by breast cancer treatment in women under 45 years old. To achieve the proposed objective, a qualitative study was carried out through a clinial-qualitative approach and content analysis. We used the open interview and the Story-Drawing procedure as the mais tools for data collection, complemented with a questionnaire of sociodemographic data and clinical data. The data were analyzed considering the framework of grief as a Psychossocial Process and psychodinamic theories allowed a more profound understanding on subjective aspects of grief process resulting from the premature menopause induced by breast cancer treatment. The data analysis allowed the identification of five categories: Devastated body and the attack on identity support: "I don't recognize myself"; Need to familiarize yourself with the new body: "Is it normal to feel this?", All of me: "My whole body has changed", Suffering associeted with infertility: "Its my Achilles tendon", "Like fire and ice": vicissitudes of sexual desire creating mismatches in the relationship with the intimate partner. It was possible to identify many symbolic losses resulting from the experience of premature menopause that were relevant to young women in treatment. The set of body changes weakens the identity base of being a young woman and anticipates some experiences related to aging. Some losses could be elaborated, while others presented complicated grief characteristics because they were not integrated into a new identity. The psychodynamic aspects identified in the context of breast cancer treatment and consequent early menopause, showed a regression of basic needs, such as need for protection and care, as well as feelings of guilt, ambivalence, fear of loss, fear of death and unprotection. Constuctive trends such as the search for autonomy, personal development and the desire to recover health were also observed. It is expected that the knowledge produced will contribute to a better understanding of symbolic grief resulted from the experience of premature menopause induced by breast cancer treatment, so that comprehensive health care for young women with breast cancer considers the repercussions of menopause on the health and life of these women assisting in the elaboration of such mourning

Insuficiencia ovárica primaria en adolescentes: revisión de la literatura a propósito de un caso clínico / Primary ovarian insufficiency in adolescents: review of the literature regarding a clinical case

El objetivo de este manuscrito es realizar una revisión y actualización de la literatura de la insuficiencia ovárica primaria (IOP) en población adolescente, a partir del diagnóstico, manejo y seguimiento de un caso clínico. La insuficiencia ovárica primaria se define como la menopausia en una mujer antes de los 40 años, acompañada de amenorrea, hipogonadismo hipergonadotrópico e infertilidad. Su prevalencia varía entre 1 a 2%, y en mujeres menores de 20 años su prevalencia es un caso de cada 10,000. Aunque se sabe que muchas afecciones pueden llevar a una IOP, la más común es la causa idiopática. La presentación clínica es diversa, y varios trastornos diferentes pueden también, llevar a esta condición. CASO CLÍNICO: Se presenta el caso de una adolescente de 17 años, previamente sana, con historia de amenorrea secundaria, no embarazada, con examen físico general y ginecológico normal. Se solicita estudio analítico complementario resultando con niveles de hormona folículo estimulante (FHS), estradiol (E2) y hormona antimülleriana (AMH) compatibles con una insuficiencia ovárica como la observada en la posmenopausia. Se inicia terapia hormonal (TH) clásica con estradiol y progesterona, siendo posteriormente reemplazada por anticoncepción hormonal combinada (AHC) oral, coincidente con el inicio de vida sexual, con respuesta favorable y sangrados regulares. La IOP tiene graves consecuencias para la salud incluyendo trastornos psicológicos como angustia, síntomas depresivos o depresión, infertilidad, osteoporosis, trastornos autoinmunes, cardiopatía isquémica, y un mayor riesgo de mortalidad. La enfermedad de Hashimoto es el trastorno autoinmune más frecuente asociado a la IOP. Su tratamiento y diagnóstico deben establecerse de forma precoz para evitar consecuencias a largo plazo. La terapia con estrógenos es la base del tratamiento para eliminar los síntomas de la deficiencia de estrógenos, además de evitar las consecuencias futuras del hipogonadismo no tratado. También el manejo debe incluir los siguientes dominios: fertilidad y anticoncepción, salud ósea, problemas cardiovasculares, función psicosexual, psicológica y neurológica, informando a los familiares y a la paciente sobre la dimensión real de la IOP y la necesidad de tratamiento multidisciplinario en muchos casos. CONCLUSIÓN: El caso presentado, pese a ser infrecuente, permite abordar de manera sistematizada el diagnostico de IOP y evaluar alternativas de manejo plausibles para evitar graves consecuencias en la salud, así como conocer respuesta clínica y de satisfacción de la adolescente.

The objective of this manuscript is to review and update the literature on primary ovarian insufficiency (POI) in an adolescent population, based on the diagnosis, management and follow-up of a clinical case. Primary ovarian insufficiency is defined as menopause in a woman before the age of 40, accompanied by amenorrhea, hypergonadotropic hypogonadism, and infertility. Its prevalence varies between 1 to 2%, and in women under 20 years of age its prevalence is one case in every 10,000. Although it is known that many conditions can lead to POI, the most common is the idiopathic cause. The clinical presentation is diverse, and several different disorders can also lead to this condition. CLINICAL CASE: The case of a 17-year-old adolescent, previously healthy, with a history of secondary amenorrhea, not pregnant, with a normal general physical and gynecological examination is presented. A complementary analytical study is requested, resulting in levels of follicle stimulating hormone (FHS), estradiol (E2) and anti-müllerian hormone (AMH) compatible with ovarian insufficiency such as that observed in postmenopause. Classic hormonal therapy (HT) with estradiol and progesterone was started, later being replaced by combined hormonal contraception (CHC), coinciding with the beginning of sexual life, with a favorable response and regular bleeding. POI has serious health consequences including psychological disorders such as distress, depressive symptoms or depression, infertility, osteoporosis, autoimmune disorders, ischemic heart disease, and an increased risk of mortality. Hashimoto's disease is the most common autoimmune disorder associated with POI. Its treatment and diagnosis must be established early to avoid long-term consequences. Estrogen therapy is the mainstay of treatment to eliminate the symptoms of estrogen deficiency, in addition to avoiding the future consequences of untreated hypogonadism. Management should also include the following domains: fertility and contraception, bone health, cardiovascular problems, psychosexual, psychological and neurological function, informing family members and the patient about the real dimension of POI and the need for multidisciplinary treatment in many cases. CONCLUSION: The case, although infrequent, allows a systematic approach to the diagnosis of POI and evaluate plausible management alternatives to avoid serious health consequences, as well as to know the clinical response and satisfaction of the adolescent.

Study of incidence of premature ovarian failure in patient attending outpatient department for infertility in a tertiary care centre

Background: To assess the incidence of premature ovarian failure in cases attending infertility outpatient Department of Obstetrics and Gynecology in a tertiary care centre. A total of 350 patients attending infertility opd were screened over period of 150 days from which authors observed premature menopause in 10 cases accounting for an incidence of 2.8%. POF affects approximately one in 10,000 women by age 20; one in 1,000 women by age 30; one in 100 women by age 40.  Premature ovarian failure is a common cause of infertility in women.Methods: Patient attending outpatient Department of Obstetrics and Gynecology with age less than 40 years and infertility, symptoms of menopause were enrolled for the study for duration of 150 days.Results: Present study authors found a total of 2.8% of patient presenting in our outpatient department for infertility had Premature ovarian failure.80% of them were symptomatic suffering with symptoms of hormonal deficiencies .100% of patient with infertility diagnosed as premature ovarian failure had low AMH and High FSH and LH levels indicating poor prognosis.Conclusions: Patient presenting with infertility and amenorrhoea can be cases of premature menopause. Here it is essential to investigate and treat the patient. Infertility might be one of the early presenting symptoms if not the first one. These patients if treated and diagnosed early can have a better living. Considering the wide spectrum of functional derangements in patient with early menopause and benefits of early hormone replacements these patients should be diagnosed and treated early.

Association between Age at Natural Menopause with Diabetes and Prediabetes

BACKGROUND: Previous studies have reported that fasting insulin and blood glucose levels are higher in postmenopausal than in premenopausal women and that insulin resistance was more serious in postmenopausal women. The effects of menopause on glucose metabolism have been well studied, but it is unclear whether age at menopause onset is associated with fasting blood sugar and HbA1c levels. The purpose of this study is to determine the effect of menopause age on diabetes and prediabetes.METHODS: We retrospectively analyzed data from the Sixth Korea National Health and Nutrition Examination Survey (2013–2015). The participants were 2,156 naturally menopausal women, except diabetes, stroke, coronary artery disease and cancer patients. The study population was divided into four groups according to the age of natural menopause onset ( < 40, 40–44, 45–55, and ≥56 years). Diagnosis of diabetes and prediabetes was based on the American Diabetes Association guideline. The association between menopause age and diabetes or prediabetes was analyzed by multiple logistic regression.RESULTS: Women reaching menopause at 40–44 years were 4.901 times more likely to have diabetes (odds ratio [OR], 4.901; 95% confidence interval [95% CI], 1.353–17.756, P=0.016) than those who reached menopause at an age of ≥56 years. Women with menopause at age < 40 years were 2.839 times more likely to have diabetes or prediabetes (OR, 2.839; 95% CI, 1.012–7.968, P=0.047).CONCLUSION: Women with premature menopause (< 40 years) have high risk of developing diabetes or prediabetes, and women with a menopause age of 40–44 years have high risk of developing diabetes.

Relationship between Early Menopause and Periodontal Disease in Korean Postmenopausal Women / 치위생과학회지

The purpose of this study was to evaluate the relationship between early menopause and periodontal disease in postmenopausal women using data from the 6th Korean National Health and Nutrition Examination Survey (2013~2015). A study was conducted with 2,048 postmenopausal women aged 45 to 74 years. Participants were divided into the early menopause group (menopause occurring at age 45 years or before) and normal menopause group (menopause occurring after age 45 years). A community periodontal index greater than or equal to code 3 was used to define periodontal treatment needs. A chi-square test was used to confirm the bivariate relationship between the variables. Multinomial logistic regression analysis was used to adjust for covariates (age, education, family income, body mass index, alcohol drinking, smoking, visiting dentist in the last year, use of oral care products, frequency of tooth brushing per day). The risk of periodontal disease was higher in the early menopause group after adjusting for potential confounders (odds ratio, 1.59). In particular, the relationship between early menopause and periodontal disease was more evident in women with low education and those who did not use oral care products. The findings of this study suggest that early menopause is a significant factor of periodontal disease in Korean women.

Perceptions and health-seeking behaviour of two young women with Iatrogenic premature menopause

Background@#Premature menopause is a frequently overlooked condition with significant morbidity without timely intervention.@*Objective@#This descriptive study explored the perceptions, concerns, and health-seeking behavior of two women diagnosed with premature menopause, regarding their illness.@*Methods@#Authors interviewed two nulligravid patients less than 30 years old diagnosed with premature menopause. Verbal consent was sought prior to the interview. An interview guide adapted from the Explanatory Model (Kleinman) to probe each patient's perceptions, concerns and health-seeking behaviour regarding PM was used. Data validation was immediately sought after the interview with each patient before analysis. Thematic analysis was used to explore the patients' perceptions (physical, psychological, and social effects of PM) and health-seeking behavior that resulted from these effects.@*Results@#Results showed that vasomotor symptoms, infertility, and treatment costs are important issues for these patients to help them undertsand their illness. The neglected role of physicians in fully disclosing the effects of the disease is highlighted in one patient that hindered her from making informed choices for treatment. The behavioural responses of these patients were influenced by the following factors: ability to make informed decisions over disease management, degree of disruption of activities of daily living, infertility, amount of social and financial support.@*Conclusion@#Looking at the underlying motivations of women diagnosed with premature menopause about their illness may help physicians better understand patients' circumstances, how it affects them and their families, and their expected recovery process.

Falla ovárica prematura / Premature ovarian failure

La Falla Ovárica Prematura (FOP) se define como la disfunción ovárica temprana diferente de la menopausia, secundaria a la disminución en la producción de los folículos, que resulta en amenorrea, concentraciones de estradiol sérico < 50 ng/mL y de la hormona folículo estimulante (FSH) > 40 mUI/mL en al menos 2 determinaciones realizada en el lapso de 4 a 6 semanas, antes de los 40 años de edad. La prevalencia es de 0,3 a 1%, y es causada por condiciones que alteran la función ovárica como las enfermedades autoinmunes, genéticas, infecciosas, inflamatorias, iatrogénicas, deficiencias enzimáticas, síndromes metabólicos e idiopática. La terapia de reemplazo hormonal (TRH) es la indicada para reducir el riesgo de osteoporosis, enfermedad cardiovascular, trastornos de ansiedad, depresión, estrés psicológico y mejorar el bienestar general y sexual. En vista del aumento de la tasa de mortalidad cardiovascular y global en estas pacientes, se hace una revisión del aspecto etiológico, diagnóstico y terapéutico de la FOP.

Premature Ovarian Failure (POF) is defined as early ovarian dysfunction different to menopause, secondary to decreased follicles production, resulting in amenorrhea, estradiol levels <50 ng/mL and follicle stimulating hormone (FSH) > 40 mIU/mL at least 2 determinations made in the period of 4 to 6 weeks, before 40 years old. The prevalence is 0.3 to 1% and is caused by conditions that alter ovarian function such as autoimmune diseases, genetic, infectious, inflammatory, iatrogenic, enzyme deficiencies, metabolic syndromes and idiopathic. Hormone replacement therapy (HRT) is indicated to reduce the risk of osteoporosis, cardiovascular disease, anxiety disorders, depression, psychological stress and improve overall and sexual well-being. In view of the increased rate of cardiovascular and overall mortality in these patients, a review is made about the etiological aspect, diagnosis and treatment of the FOP.

Autosomal Translocation Patient Who Experienced Premature Menopause: A Case Report

Premature ovarian failure (POF) is a condition in which the ovarian functions of hormone production and oocyte development become impaired before the typical age for menopause. POF and early menopause are present in a broad spectrum of gonad dysgenesis, from a complete cessation of ovarian function to an intermittent follicle maturation failure. Actually POF has been identified as a genetic entity (especially chromosome X), but data on genetic factors of premature menopause are limited. Until now, several cases revealed that inactivation of X chromosomes has an effect on ages of premature menopause and females with balanced or unbalanced X-autosome translocations can have several reproductive problems. On the other hand, there have been a few data that was caused by autosome-autosome translocation can lead. Therefore we report a relevant case of POF with translocation between chromosomes 1 and 4. She had her first menstrual period at the age of 12, and after 7 years she stopped menstruation. Chromosomal analysis showed 46, XX, t (1;4) (p22.3;q31.3). While evaluating this rare case, we could review various causes (especially genetic factors) of POF. To remind clinicians about this disease, we report a case of POF caused by autosome-autosome translocation with a literature review.

Falência ovariana precoce / Premature ovarian failure

Este artigo irá rever os diversos aspectos da falência ovariana prematura (FOP), definida como o desenvolvimento de hipogonadismo em mulheres antes dos 40 anos, desde a etiopatogenia, com discussões sobre as causas autoimunes, iatrogênicas, ou anormalidades do cromossomo X assim como manifestações clínicas, diagnóstico e tratamento. A maioria das mulheres com essa condição não possui uma história menstrual, específica do desenvolvimento da FOP, mas a infertilidade associada ao diagnóstico é o aspecto mais problemático da doença. Arq Bras Endocrinol Metab. 2014;58(2):132-43.

This article is a review on different aspects of premature ovarian failure (POF) defined as the development of hypogonadism in women before 40 years of age. The review will discuss the etiopathogeny, autoimmune and iatrogenic causes, abnormalities of chromosome X, as well as clinical manifestations, diagnosis, and treatment. Most of the women with this disorder do not have menstrual history, specific of POF development, but infertility associated with the diagnosis is the most problematic aspect of the disease. Arq Bras Endocrinol Metab. 2014;58(2):132-43.

Osteoporosis and Osteoporotic Fracture in Premature Menopause / 대한골다공증학회지

Premature menopause is well known risk factor for osteoporosis and fragility fracture. Although its definition is menopause before the age of 40, many studies about the risk of osteoporosis and fragility fracture use diverse definition for it as early menopause. This article is to review the data of the impact of premature or early menopause on bone density and fragility fractures.

Women with primary ovarian insufficiency have lower bone mineral density

The aim of the present study was to assess the prevalence of osteoporosis in a sample of 32 patients with spontaneous primary ovarian insufficiency (POI) in comparison to reference groups of 25 pre- and 55 postmenopausal women. Hip (lumbar) and spinal bone mineral density (BMD) measurements were performed by dual-energy X-ray absorptiometry in the three groups. The median age of POI patients at the time of diagnosis was 35 years (interquartile range: 27-37 years). The mean ± SD age of postmenopausal reference women (52.16 ± 3.65 years) was higher than that of POI (46.28 ± 10.38 years) and premenopausal women (43.96 ± 7.08; P = 0.001) at the time of BMD measurement. Twenty-seven (84.4 percent) POI women were receiving hormone replacement therapy (HRT) at the time of the study. In the postmenopausal reference group, 30.4 percent were current users of HRT. Lumbar BMD was significantly lower in the POI group (1.050 ± 0.17 g/cm²) compared to the age-matched premenopausal reference group (1.136 ± 0.12 g/cm²; P = 0.040). Moreover, 22 (68.7 percent) POI women had low bone density (osteopenia/osteoporosis by World Health Organization criteria) versus 47.3 percent of the postmenopausal reference group (P = 0.042). In conclusion, the present data indicate that BMD is significantly lower in patients with POI than in age-matched premenopausal women. Also, the prevalence of osteopenia/osteoporosis is higher in POI women than in women after natural menopause. Early medical interventions are necessary to ensure that women with POI will maintain their bonemass.

Falência ovariana precoce em portadores da pré-mutação do gene FMR1: revisão da literatura / Premature ovarian failure in FMR1 premutation carriers: a literature review

A mutação do gene FMR1 é um fator genético importante para a determinação multifatorial da idade da menopausa. Portadoras da pré-mutação podem ter a vida reprodutiva encurtada e devem ser alertadas sobre o risco de transmissão da Síndrome do X Frágil para seus descendentes. O objetivo deste trabalho foi mostrar dados atualizados sobre as implicações genotípica e fenotípica da pré-mutação do gene FMR1 na reprodução humana.

The FMR1 mutation is an important genetic factor in the multifactor determination of menopause age. Premutation carriers can have reproductive life shortened and should be alerted about the risk of transmitting the Fragile X Syndrome to their descendents. The purpose of this paper was to show updated data about the genotypic and phenotypic implications of FMR1 premutation on human reproduction.

Non-vertebral Fractures due to Recurrent Falls after Premature Menopause / 대한폐경학회지

Premature menopause is due to ovarian dysfunction. Premature menopause is characterized by arrested folliculogenesis before 40 years of age. Premature menopause is associated with health problems. The impact of estrogen deficiency tends to be chronic problems rather than acute. We have managed a case of recurrent non-vertebral fractures due to falls after premature ovarian dysfunction. We present this case with a brief review of the literature.

The Incidence of Chemotherapy-induced Amenorrhea and Recovery in Young (<45-year-old) Breast Cancer Patients / 한국유방암학회지

PURPOSE: Although adjuvant chemotherapy improves the survival of premenopausal breast cancer patients, it could induce the premature menopause. The objective of this study was to investigate the incidence and risk factors of chemotherapy-induced amenorrhea (CIA) and recovery for young ( 30 mIU/mL. RESULTS: A total of 324 patients were included in this study. Of these patients, 261 patients (80.6%) developed amenorrhea just after the completion of chemotherapy. During follow-up, 77 patients (29.5%) resumed menstruation. Amenorrhea rates at 6, 12, 24, and 36 months after chemotherapy were 72.2%, 66.6%, 58.1%, and 55.5%. Women who recovered from amenorrhea were significantly younger than the women who did not recover (p<0.001). Patients treated with cyclophosphamide, methotrexate and 5-fluorouracil (CMF) less frequently recovered from amenorrhea than patients who were treated with anthracycline or taxane-based chemo- therapy (p<0.001). CONCLUSION: The age of the patient was the most important factor for the development of CIA. Patients treated with a CMF regimen and older patients showed poor recovery from CIA. These results could be helpful to make decisions about the treatment strategies for premenopausal young women.

The Effect of 2-bromopropane, organic solvent on ovarian function of reproductive women: 7-years follow-up / 대한산부인과학회잡지

OBJECTIVE: We conducted a study of the effect of an organic solvent on the failure of ovarian function after exposure to 2-bromopropane for 7 years. METHODS: We conducted a study on 25 female workers in a manufactory who were exposed to 2-bromopropane in 1994. Some of them experienced premature ovarian failure. We have investigated their recoveries from ovarian function and checked LH, FSH, E2, BMD for 7 years of period. RESULTS: 16 among 25 workers experienced amenorrhea, but the rest of them did not report amenorrhea. In 10 out of the 16 amenorrhea patients, recovery from amenorrhea were seen, but 6 did not recover from amenorrhea. Through ovarian biopsy, it was observed in the amenorrhea patients that mature follicles were lost and only primordial follicles were present. Through HRT, gradual decrease in FSH and increase in E2. in the amenorrhea patients were found. Also, their BMD were decreased, but gradually increased with female hormone replacement therapy. CONCLUSION: The study confirms that the exposure to 2-bromopropane leads to the serious ovarian toxicity and ovarian failure as well. In such case, the failure of ovarian function, which is reversible change, can be recovered after long-term periods. A significant factor which affect ovarian failure and recovery from ovarian function is patient's age. In industrial environment, physical and psychological damage due to the use of and exposure to chemical materials will likely increase. Hence, more studies of industrial materials used in working conditions are needed.

Two Cases of Female Sexual Dysfunction Treated by Estrogen and Testosterone / 대한남성과학회지

Female sexual dysfunction is now of great concern and have a relatively high prevalence. It is related with psychosocial disorder, organic disease and iatrogenic cause. But until recently, basic science and clinical study on it is limited and medical therapy stays in early experimental steps except conventional hormone replacement therapy. Hormonal based female sexual dysfunction can be caused by dysfunction of the hypothalamic-pituitary axis, surgical or medical castration, menopause and premature ovarian failure. We report two cases of female sexual dysfunction derived from hormonal deficiency. One case is about premature menopause induced and the other is about rare form of adult onset idiopathic hypogonadotropic hypogonadism.

Ovarian Recovery after Bone Marrow Transplantation in Aplastic Anemia / 대한산부인과학회잡지

OBJECTIVE: Ovarian failure is often common complication by the conditioning protocol used for bone marrow transplantation (BMT). To determine the frequency of recovery of ovarian function after allo-BMT and the major factor that predict recovery, we monitored ovarian function in 24 premenopausal women METHOD: Twenty-four women met the inclusion criteria, which were (1) moderate to severe aplastic anemia before BMT, (2) disease-free at least 18 month after transplantation, (3) age younger than 40 years and more than 3 years after menarche at transplantation and (4) regular menstrual periods before transplantation. Recovery of ovarian function was determined by regular menses without menopausal symptom and sign. we divided conditioning regimen to two groups, Group I : cytoxan alone(n=17), Group II : cytoxan plus total body irradiation (TBI)(n=7). RESULTS: All women became amenorrhea after BMT and the clinical characteristics were not significant between two groups. 17 patients who received only cytoxan all recovered ovarian function between 1 to 14 months(median : 7.28) after BMT. The median age at BMT of women with regained ovarian function was 26 years (range, 21 to 33) versus 30 (range, 21 to 37) for those who did not. The age at transplantation was not significant between two groups in our study and the most predictive independent factor in ovarian recovery is the presence of total body irradiation. None of women who received TBI regained ovarian function during 19-49 month follow up. CONCLUSION: Gonadal insufficiency due to pre-BMT conditioning is more severe in radiation based regimen than cytoxan alone. therefore, we recommend early hormone replacement therapy in radiation treated women to prevent the complication of premature menopause.