[Hormonal disorders, menstrual irregularities and future fertility]. / Hormonelle Störungen im Zusammenhang mit Blutungsanomalien und späterer Fertilität.

Menstrual irregularities are common in puberty and adolescence during the development of ovarian function and until a regular ovulatory cycle is established. Hormonal disorders should be investigated promptly to avoid or alleviate possible long-term sequelae, including impaired fertility. Most irregularities are transient and self-limited, but some are severe or prolonged and require exploration and treatment. Symptoms such as prolonged oligomenorrhea andoligoamenorrhea may herald an incipient or preexisting endocrinopathy. An exact diagnosis by estimation of the hormonal parameters can identify a relevant disturbance. The prognosis for later fertility in patients with oligoamenorrhea depends on the etiology and degree of the condition. With a hypothalamic origin the prognosis is good when the offending stimuli are removed. Patients with pituitary lesions or hyperprolactinemia can be treated effectively. Hyper-androgenemic oligoamenorrhea, especially the polycystic ovarian syndrome, are common. Future fertility is reduced but may be improved by preventive measures and therapy in adolescence. Inpatients with primary ovarian insufficiency and persisting hyper-gonadotropic amenorrhea, the prognosis for fertility is poor.

[Menstrual cycle anomalies in young girls--prognosis concerning later fertility]. / Zyklusanomalien bei jungen Mädchen--Prognose betreffend spätere Fertilität.

Menstrual disorders in adolescents should be investigated promptly to avoid or alleviate possible long-term sequelae, including impaired fertility. Patients with uterine amenorrhea cannot become pregnant. The prognosis for later fertility in patients with oligoamenorrheas depends on the pathogenesis and degree of the condition. Hypothalamic oligoamenorrheas generally resolve when the offending stimuli are removed, and the prognosis for future fertility is good. In patients with pituitary lesions, even those with complete loss of pituitary function, pregnancies can be achieved and maintained with exogenous gonadotropins. Menstrual disorders due to hyperprolactinemia can be treated effectively. Hyperandrogenemic oligoamenorrheas, especially the polycystic ovary syndrome, are common. Future fertility has been improved with preventive measures in adolescence and later interventions. Patients with primary ovarian insufficiency and persisting hypergonadotropic amenorrhea have a poor prognosis. A new aspect is the restitution of ovarian function after treatments for malignant diseases.

Kinder- und Jugendgynakologiekongresse. bericht der osterreichischen arbeitsgemeinschaft fur kinder- und jugendgyn akologie, sektion der osterreichischen gesellschaft fur gyn akologie und geburtshilfe

Leider besteht fur diesen Artikel keine Zusammenfassung. Als Einstieg stellen wir den Textanfang zur Verfugung. Vom 20. bis 22. Februar 1998 fand das 3. Berliner Symposium fur Kinder- und Jugendgynakologie statt; Veranstalter war die Deutsche Arbeitsgemeinschaft Kinder- und Jugendgynakologie in Zusammenarbeit mit der Osterreichischen und Schweizerischen Arbeitsgemeinschaft Kinder- und Jugendgynakologie. Das Symposium wurde in bewahrter Form von Marlene Heinz organisiert und war wieder ein grosser Erfolg, gekennzeichnet durch einen ausgezeichneten Besuch.

Female genital tract malignancies during puberty. Uterine and cervical malignancies.

Malignancies of the uterine corpus are extremely rare. Diagnostic and therapeutic procedures should be performed according to oncological principles with individually adapted treatment regimes. Clinical cancer of the cervix is rare in adolescence; the treatment is radical surgery. Preclinical stages, that is, CIN III (severe dysplasia, carcinoma in situ) and microinvasive cancer (stages Ia1, Ia2), are important, also because of their frequency. Diagnosis is based on colposcopy, cytology, direct biopsy, histological examination, and conization. In addition, virology (HPV) and DNA cytometry may become prognostic factors. Treatment consists of conization with an exact histological examination in serial sections as a basis for preserving the uterus. The sarcoma botryoides is localized in the cervix in adolescence, whereas it is in the vagina in infants and children.

[Drug information in hormone substitution drugs]. / Zur Problematik der Gebrauchsinformation von Hormon-Substitutionspräparaten.

The package leaflets of hormone preparations used for Hormone Replacement Therapy (HRT) in hypoestrogenaemic women contain contraindications, which are taken from the package insert of oral contraceptives: Clots in the blood vessels (thrombotic disorders), high blood fats, severe diabetes, abnormal red blood cells, deterioration of inherited deafness and jaundice not explained by infections, disturbances of the liver function and of existing or treated hormone-dependent tumours of the breast or of the lining of the womb. Numerous epidemiologic, animal-experimental and also clinical studies proved that the cardiovascular risk, hepatic discomfort and the influence on the blood system of oestradiol 17-beta have to be evaluated completely differently compared to the ethinyloestradiol used in oral contraceptives; therefore, many of the listed contraindications must be reconsidered. In our review we try to emphasise this postulation by scrutinizing recent publications.

[Benefits and risks of hormonal contraception]. / Nutzen und Risiko der hormonellen Kontrazeption.

PIP: In addition to oral contraceptives (OCs), the morning-after pill, the minipill, and depot preparations also belong to hormonal contraceptives. The latter two contraceptives have not become established among young women because of inadequate cycle control. For postcoital contraception in Austria, Neogynon and Stediril-D, consisting of 0.05 mg of ethinyl estradiol (EE) + 0.25 mg of levonorgestrel, are used within 48 hours of unprotected intercourse. Lower dose OCs have considerably reduced the risks of side effects. Micropills are the optimal OCs with EE under 50 mcg combined with the new generation of gestagens. The beneficial effects include menstrual regularity and the prevention of anemia, ovarian cysts, and fibrocystic mastopathy. Nausea, headache, spotting, and weight gain do occur in individual cases, even among young people. The potential risk of thromboembolism is the most important, although arterial cardiovascular risk is minimal in young age. The probability of postpill amenorrhea is less than 1%. Micropills can be used by young diabetics provided the disease is not beyond 10 years' duration and there is no angiopathy. Acne, seborrhea, and hirsutism are beneficially influenced by a combination of 0.035 mg of EE with 2 mg of cyproterone acetate. The relative risk of endometrial and ovarian cancer are only about half as high among OC users as among nonusers. The risk of breast cancer in young OC users has not been conclusively explained. Regular colposcopy and cytology is recommended for young OC users to preclude the risk of malignancies of the genital tract. Sex education and the use of OCs that are the most suitable and effective for young people can reduce the number of unwanted pregnancies and abortion. The comparison of two 5-year periods in the 1970s and 1980s at the University Obstetrical-Gynecological Clinic in Graz showed that the incidence of births among women under 18 years of age decreased from 3.6% (778) to 1.6% (353).^ieng

[Favorable concomitant effects and undesirable side effects of oral contraceptives]. / Günstige Begleitwirkungen und unerwünschte Nebenwirkungen oraler Kontrazeptiva.

Oral contraceptives can cause favourable or adverse unintended effects. Severe adverse side effects could be reduced by lowering the estrogen dose and lowering the dose and changing the structure of progestogens. So favourable side effects have gained in importance such as correcting disorders of the menstrual bleeding pattern, positive influence on functional ovarian cysts, benign breast diseases, the skin. Concerning the risk for neoplasm there is a certain protective effect against endometrial and ovarian cancer and no higher risk for breast cancer. Medically important adverse side effects on the cervix, the menstrual pattern, the liver and gallbladder, the central nervous system and psyche, or severe side effects like thromboembolic diseases are significantly reduced by dose reduced compounds containing newly developed progestogens. Interactions between oral contraceptives and other drugs are of little clinical significance.

[Pregnancy following cytostatic treatment of trophoblast tumor]. / Schwangerschaften nach zytostatischer Behandlung von Trophoblasttumoren.

Observation of 18 pregnancies in 13 women who had undergone treatment for trophoblastic neoplasm with cytostatic drugs confirmed reports according to which the risk of miscarriage, premature birth, stillbirth, and severe congenital anomalies is not increased. Seven low-risk patients who had been treated with methotrexate gave birth to 10 children who were mature except for one pair of premature twins. Only one child had an anomaly, i.e. celiac disease, but this could not be linked to the prior treatment. Three high-risk patients who had been treated with methotrexate or methotrexate with actinomycin-D gave birth to four children, all of whom were mature and healthy. Intensive prenatal care, and in particular diagnosis at the beginning of pregnancy, are of great importance. At least one year must elapse between termination of chemotherapy and the beginning of a pregnancy. Effective contraception must be assured during this time.

[Development of dysgerminomas from gonadoblastomas (report of 2 cases with XY gonadal dysgenesis)]. / Zur Dysgerminomentwicklung aus Gonadoblastomen (Bericht über 2 Fälle mit XY Gonadendysgenesie).

Gonadoblastomas have a propensity to give rise to malignant germ cell neoplasms. This report analyzes the clinicopathologic findings in two phenotypic females with features of 46, XY pure gonadal dysgenesis, who developed dysgerminomas in gonadoblastomas. All stages in the evolution of the dysgerminomas from the germ cells in gonadoblastomas were observed. The pathogenesis of the XY gonadal dysgenesis is briefly discussed. Finally the strict recommendation is given to remove the streak gonads with and without tumors in such individuals.

[Value of laboratory parameters in androgenization in the female with special reference to the "free androgen index"]. / Die Wertigkeit von Laborparametern bei Androgenisierungserscheinungen der Frau unter besonderer Berücksichtigung des "freien Androgen-Index".

The degree of androgynism (A) in women can be assessed via clinical data and by determining the levels of testosterone (T), dehydroepiandrosterone sulfate (DHEA-S) and testosterone binding globulin (TBG) in the blood. The determination of the "free androgen index" (FAI), the ratio of total T and TBG, helpful in estimating the level of free T in serum, conveys valuable additional information: in case of FAI below 1, a mild kind of A without elevation of free testosterone can be assumed. However, severe A with elevation of free testosterone and absolute hyperandrogynism is associated with FAI values above 1. In 63 women with signs of A the parameters mentioned above and the FAI were used to determine the degree of severity of A. These data were compared with the corresponding data of a control group. It could be shown that in women whose A was due to idiopathic hirsutism the increased level of bonded T played a causal role. The mean FAI in this group was 0.41. In contrast, in women with POC syndrome and androgynous cycle disturbances, the absolute hyperandrogynism with elevation of free T levels predominated. In these groups the mean FAI was above 1. However, women with male pattern bolding as single sign of A did not exhibit any significant difference in comparison to the control group. In this disease, the increased response of androgen receptors in the skin despite normal androgen levels seems to play a causal role. Two cases of androgen producing ovarial tumours and one case of adrenogenital syndrome were analysed separately.

[Selective venous catheterization in the evaluation of androgenism]. / Selektive Venenkatheterisierung zur Abklärung von Androgenisierungserscheinungen.

In cases of rapidly increasing androgenism, virilism and androgenetic cycle disturbances it is essential to exclude the presence of an androgen-producing tumour. Serum levels of testosterone above 1.5 ng/ml and dehydroepiandrosterone sulphate values above 6700 ng/ml are suggestive of tumour. Functional tests, laparoscopy and imaging modalities are often less efficient. Selective vein catheterisation enables the diagnosis and localisation of such hormone-producing neoplasms (Kirschner and Jacobs, 1971). This paper presents the case report of the diagnosis of a Leyding cell tumour of the right ovary by means of selective vein catheterisation. The tumour was not palpable and had not been detected on laparoscopy. The procedure is extensively described and discussed.

[The pulsatile administration of releasing hormone (GnRH) for the treatment of hypothalamic amenorrhea]. / Die pulsatile Releasinghormon-(GnRh-)Gabe zur Behandlung der hypothalamischen Amenorrhö.

12 women with hypothalamic amenorrhoea (degrees II to IIIb) were given pulsatile releasing hormone in 14 treatment cycles. The minipump "Zyklomat" (Ferring Ges.m.b.H., Kiel) with a treatment set giving 0.8 mg LH-RH was used in all cases. In 86% (12 out of 14) of the treated cycles ovulation was recorded. 3 out of 8 women who desired a baby became pregnant. 1 of these pregnancies followed directly on a treatment cycle whilst the other 2 pregnancies resulted from spontaneous biphasic cycles following the treatment cycle. In 4 women pulsatile releasing hormone was used to examine the functional reaction of the pituitary gland and the ovary. In this group 1 spontaneous biphasic cycle was seen following the induced ovulatory cycle.

[Pregnancies following tubal diagnostic procedures]. / Schwangerschaften nach tubendiagnostischen Massnahmen.

During the years 1976 to 1980, 178 laparoscopies with hydropertubations and 113 hysterosalpingographies as well as 24 combined tests were carried out at the University Clinic of Obstetrics and Gynecology Graz. Of these, 263 cases could be evaluated. On the basis of the diagnosis made by above mentioned examinations, a pregnancy was practically impossible for 102 women. Of the remaining 161 cases, 38 (23,6%) conceived within the first six cycles subsequent to "invasive diagnosis". It is assumed that these patient's pregnancies can be attributed directly to the diagnostic measures. It is presumed that the reason for this therapeutic effect lies in the removal of a mechanical or psychic disturbance.

[Sterility in hyperprolactinemic amenorrhea]. / Sterilität bei hyperprolaktinämischer Amenorrhoe.

Infertility caused by hyperprolactinemic amenorrhea may be complicated by pituitary adenoma. In a group of 36 women with amenorrhoea-hyperprolactinemia-syndrome were 15 infertility-patients. 10 of them had prolactin levels above 100 ng/ml. In 6 patients a prolactinoma was removed microsurgically. In every case further treatment was necessary to get normal cycles. 8 of these 10 infertility-patients became pregnant.

[Androgenetic amenorrhea]. / Die androgenetische Amenorrhoe.

Virilism in females is often associated with menstrual disorders. There is an evident correlation between the severity of virilism, the level of androgens and the degree of menstrual disorder. A study was carried out between January 1978 and December 1980 on 75 women with various degrees of virilism. The majority of women with severe hirsutism and male-type alopecia were found in the group with amenorrhoea. Furthermore, the four cases with the full-blown picture of severe virilism were found exclusively in this group. Clarification of the virilizing manifestations on the basis of a determination of the basic hormonal status (including the steroid fractions), the dexamethasone suppression test (including the HCG stimulation test) and the oestrogen-gestagen suppression test, diagnostic laparoscopy and phlebography of the adrenal gland is discussed and the methods evaluated.

[Results of the treatment of trophoblast tumours (author's transl)]. / Ergebnisse der Behandlung von Trophoblasttumoren.

Within 10 years 24 patients were treated for choriocarcinoma. Experience with new methods of diagnosis, treatment and followup was gained. 11 patients were considered to be in a low risk group and 13 patients were categorized as high risk patients. The treatment was primarily conservative. Patients with low risk received single treatment with methotrexate. In some cases in the high-risk group combination chemotherapy or polychemotherapy was used. In addition to the clinical findings, the results of the treatment are monitored with serial beta HCG determinations. Of the 11 patients in the low-risk group all well and free of recurrence. Of the high-risk group 6 patients died. Of the total of 24 patients with choriocarcinoma 18 (75%) are well and free of recurrence.