LH/FSH ratio: a better marker of secondary amenorrhea in patients from eastern Nepal.

FSH, LH and prolactin (PRL) levels were assessed by ELISA in 50 cases with secondary amenorrhea and 52 age and sex-matched healthy controls from eastern Nepal. Cases were diagnosed by differential diagnosis, and data were analyzed using standard statistical tools. Early stage (3-6 months) and long standing (> 6 months) secondary amenorrhea had no effect (p > 0.05) in hormonal parameters studied. Pulse, SBP, DBP, weight, height, age of menarche, cycle interval and duration of flows were homogenous (p > 0.05) in patients and controls. Median age of menarche, median cycle interval and median duration of flows in healthy subjects were 14 years, 30 and 4 days respectively. FSH in cases (15.38 +/- 7.24 mU/ml) was significantly elevated (p < 0.01) as compared to controls (9.38 +/- 6.34 mU/ml). LH in cases (35.44 +/- 24.35 mU/ml, median 36.5 mU/ml) was significantly (p < 0.01) elevated by almost 5 times of its mean value and 9 times of its median value as compared to that of controls (7.58 +/- 6.604 mU/ml, median 4.2 mU/ml). LH/ FSH ratio in cases (2.44 +/- 1.73, median 2.00) was significantly higher (p < 0.01) as compared to controls (0.82 +/- 0.42, median 0.76). FSH e"12 mU/ml, LH e"10 mU/ml and LH/FSH ratio e"1 cut offs were significantly associated (p = 0.000 in each) with the cases as revealed by chi-square analysis, and LH/FSH ratio e"1 (Sensitivity = 84.0%, specificity = 77.0%) was found to be a stronger marker of secondary amenorrhea. As the elevation of LH was more pronounced than that of FSH, this study hints towards possible LH receptor mutation, which is generally found in premature ovarian failure (POF). Diagnosis of cases in this region may need a new cut off level for POF, as the elevation of FSH itself was not as pronounced as reported by other workers.

¿Son los niveles de prolactina y estradiol al tercer mes posparto factores predictores del tiempo de aparición de la primera menstruación posparto?: Modelo predictivo mediante análisis de sobrevida / Post suckling prolactin and estradiol levels as predictors of the time of appearance of the first post partum menstruation

Background: The variability in the duration of lactational amenorrhoea (LA) lead to develop statistical multivariate models to predict the risk of the appearance of the first postpartum menstruation. Aim: To estimate the probability of recovering the first postpartum menstruation by means of a survival analysis, including hormonal levels and other parameters as predictor variables. Material and Methods: Eighty one mothers in exclusive breastfeeding until the sixth postpartum month, in whom estradiol, basal and post suckling prolactin were measured at the third post partum month, were studied. The variables that better predict the appearance of the first menstruation between the 3rd and 12th postpartum months, were identified using a Cox model survival analysis. Results: The median amenorrhea survival time (the lapse when the chance of recovering menstruation is 50 percent) was 209 days from delivery. Dichotomized estradiol and post suckling prolactin were the only significant variables that predicted the return of menstruation, with cutoff points of 190 pmol/ and 2,550 mIU/L, respectively. Conclusions: Post suckling prolantin and estradiol levels, measured at the third post partum month, are predictors for the time of appearance of the first postpartum menstruation.

relationship between prolactin level and the duration of lactational amenorrhoea in lactating Sudanese women

This study aimed to assess the relationship between the prolactin [PRL] level and the duration of lactational amenorrhoea in lactating Sudanese women. Sudanese women [135] from Omdurman area with different ages [18- 41 years] and stages of lactation were included, 61 of them participated by giving venous blood samples and filling a questionnaire, while the others by filling the questionnaire only. Pregnant women, contraceptives users, and hypothyroid patients were excluded. The subjects were divided into lactational amenorrhoeic [Group I], and lactating menstruating subjects [Group II]. Then each group was subdivided according to the duration of lactation into: - Lactating for six months or less. Lactating for more than six months. Prolactin level was measured using radioimmunoassay [RIA]. In this study the mean prolactin level in-group I [2934.99 mU/L] was significantly higher compared with group II [707.46 mU/L] [P<0.05]. For the duration of lactation, PRL level in the first six months was higher [4414 mU/L], [1506.60 mU/L] in group I, and group II respectively, while this level decreased after six months [1538 mU/L], [517.19 mU/L] for the two groups. Also we found that factors like breast-feeding patterns, utilization of supplementary foods, and the number of parities had a significant effect on the duration of lactational amenorrhoea. There was a positive relationship between PRL level and the duration of lactational amenorrhoea [r=0.39]

Perfil hormonal sexual de mulheres em programa crônico de diálise em tratamento com eritropoetina humana recombinante / Sex hormones profile in women on dialysis program in treatment with erythropoietin

A IRC (insuficiência renal crônica) terminal é acompanhada por alterações sistêmicas, inclusive do eixo hipotálamo-hipofisário-gonadal. Após o aparecimento da EPO (eritropoetina humana recombinante), surgiram relatos de melhora da disfunção sexual em homens, havendo relativa escassez de dados sobre dosagens hormonais e função sexual das mulheres. No Brasil, há poucos dados sobre o perfil hormonal de mulheres em programa crônico de diálise. OBJETIVOS: Avaliação e comparação do perfil hormonal sexual, através das dosagens de FSH (hormônio folículo estimulante), LH (hormônio luteinizante), PRL (prolactina) e E2 (estradiol) de mulheres em programa crônico de diálise, sob terapêutica com EPO. MÉTODOS: Foram avaliadas 47 mulheres (uma em diálise peritoneal intermitente, quatro em diálise peritoneal ambulatorial contínua e 42 em hemodiálise), subdivididas em três grupos: (1) Grupo I, de mulheres com menos de 48 anos de idade e menstruando regularmente; (2) Grupo II, de mulheres com menos de 48 anos de idade e amenorreicas; (3) Grupo III, de mulheres com mais de 48 anos de idade e amenorreicas. Os grupos foram comparados entre si através do teste de Mann-Whitney para duas amostras independentes. RESULTADOS: Todos os grupos mostraram valores normais das dosagens séricas de FSH, LH e E2, e não houve diferença estatisticamente significante nos níveis desses hormônios entre as mulheres que menstruam e as amenorreicas com idade inferior a 48 anos. Os níveis de PRL encontravam-se acima da normalidade em todos os grupos, independentemente da idade e do padrão menstrual, não havendo diferenças estatísticas significantes entre os grupos. As pacientes do grupo III apresentaram perfis hormonais compatíveis com a menopausa, ou seja, níveis séricos de FSH e LH elevados e de E2 diminuídos

Maternal prolactin concentrations and lactational behaviour in the early postpartum period in women with lactational amenorrhoea.

OBJECTIVE: To compare early postpartum differences in maternal prolactin concentrations and lactational behaviour between women who have short and long periods of lactational amenorrhoea. METHODS: Healthy lactating women resuming regular menstruation before 24 weeks [short amenorrhoea (SA) group; n = 15], and at or after 24 weeks [long amenorrhoea (LA) group; n = 15] postpartum were studied from 4 to 12 weeks postpartum. Infant feeding pattern and maternal plasma prolactin concentrations were compared between the two groups using repeated measures ANOVA. RESULTS: Breastfeeds/24 h were significantly higher and other feeds/24 h were significantly lower (p < 0.01) at 12 weeks postpartum in the LA group when expressed as a percentage of all feeds. Number of breastfeeds (total/24 h and night) significantly decreased and the number of other feeds significantly increased (p < 0.05 to 0 < 0.001) with time in both groups. Prolactin concentrations (basal, suckling stimulated and increment) were higher in the LA group, but consistent significant differences were observed mainly in the increment (p < 0.05 to p < 0.001). Prolactin concentrations significantly (p < 0.01 to < 0.001) decreased with time postpartum in the SA group, but not in the LA group. CONCLUSIONS: Women with longer periods of lactational amenorrhoea maintain higher prolactin concentrations than those with shorter periods of lactational amenorrhoea during the early postpartum period, even when the breastfeeding frequency is reduced. This could be explained by a greater sensitivity of the pituitary lactotrophe to the suckling stimulus in women who have longer periods of lactational amenorrhoea.

Amenorréia: diagnóstico etiológico e princípios terapêuticos / Amenorrhea: etiologic diagnosis and therapeutic rules

A amenorréia é uma manifestaçao clínica comum a múltiplos distúrbios em vários níveis do sistema endócrino ou genital. A investigaçao das amenorréias é frequentemente onerosa para o sistema de saúde e desgastante para a paciente, em geral porque um grande número de exames sao solicitados, muitas vezes redundantes e desnecessários. Neste trabalho, definimos uma estratégia de investigaçao individualizada com base em alguns dados-chave da história e exame físico que permitam estabelecer hipóteses diagnosticas considerando o(s) nível(is) provável(is) de comprometimento, os procedimentos complementares a serem realizados e os princípios terapêuticos a serem seguidos.

Niveles de estradiol plasmático y duración de la amenorrea de lactancia / Plasmatic estradiol levels and length of lactational amenorrhea

En Temuco, Chile, se estudiaron 114 mujeres en lactancia exclusiva de acuerdo a la duración con la amenorrea de lactancia y su relación con los niveles de estradiol plásmático al tercer mes postparto. Sesenta y seis madres (58 por ciento ) recuperaron la menstruación antes del sexto mes postparto. La duración de la amenorrea de lactancia fue de 100,7+ - 5,28 y 277,9 + - 10,5 días para aquellas con menstruación y amenorrea respectivamente. Los niveles de estradiol fueron 99 pmol/l mayores en las mujeres con corta duración de amenorrea de lactancia (p=0,0001). Este estudio confirma la corta duración de amenorrea de lactancia descrita en población chilena. La diferencia en los niveles de estradiol puede ser un indicador de la recuperación precoz de la fertilidad postparto

The efficacy of lisuride in the treatment of hyperprolactinemic amenorrhea.

Thirteen women with hyperprolactinemic amenorrhea were treated with lisuride (Dopergin, Schering AG, Germany). The dosage of lisuride was started with 0.1 mg per day and increased to 0.2 mg per day after one week of treatment. Further increment of the drug depended on clinical and laboratory responses of the patients. One patient dropped out from the study due to marked nausea and dizziness. In ten out of twelve patients serum prolactin decreased to normal. Most patients received lisuride 0.2-0.4 mg per day. Only one got more than 0.4 mg per day. Two patients whose serum prolactin levels did not decrease to normal range had uterine bleeding, quite regularly. Menstrual cycle resumed within 23 to 141 days. All galactorrhea disappeared during treatment. Two of five patients who desired pregnancy became pregnant during the treatment. The course and outcome of pregnancies were normal. Common side effects of lisuride treatment were nausea and dizziness. In conclusion, this study demonstrated that lisuride is another effective prolactin inhibiting agent even at low dose. This drug provides an alternative treatment to bromocriptine.

Aspectos fisiopatológicos del síndrome de amenorrea galactorrea-normoprolactinémico / The physiopathological aspects of teh normoprolactinemic amenorrhea-galactorrhea syndrome

Para entender en parte la fisiopatología de mujeres con amenorrea-galactorrea-normoprolactinémica (Grupo I: N=5), se establecieron comparaciones Vs. Mujeres con moderada (II; N = 4) y severa hiperprolactinemia y evidencia de tumor (III; N = 4). Se midio PRL y LH en condiciones basales y se valoró la influencia indirecta de dopamina (DA) sobre hipófisis e hipotálamo al emplear un bloqueador a nivel de receptor de DA, metoclopramida (MCP). Fue evidente una mayor disponibilidad de DA a nivel de los lactótropos, ya que después de MCP el grupo I incremento enormemente los niveles de prolactina (PRL), aunque los niveles de PRL basales eran normales. Indirectamente y por la respuesta de LH se detectó una influencia negativa de DA sobre las neuronas productoras de hormona liberadora de gonadotropinas (GnRH) ya que MCP incremento LH en los tres grupos (mayor en I y III) lo cual ha sido relacionado a un mayor recambio de DA a nivel tuberoinfundibular propio de los estados hiperprolactinémicos. La respuesta de LH - PRL a bromocriptina no mostro diferencias que consignar en ninguno de los tres grupos