Contemporary Endocrinology Series Editor P. Michael Conn, PhD Oregon Health & Science University Beaverton, OR For other titles published in this series, go to www.springer.com/series/7680
Nanette F. Santoro Genevieve Neal-Perry Editors Amenorrhea A Case-Based, Clinical Guide
Editors Nanette F. Santoro Department of Obstetrics and Gynecology University of Colorado Denver School of Medicine Aurora, CO, USA Nanette.Santoro@ucdenver.edu Genevieve Neal-Perry Department of Obstetrics and Gynecology Division of Reproductive Endocrinology and Infertility Albert Einstein College of Medicine Bronx, NY, USA Sienna3598@aol.com ISBN 978-1-60327-863-8 e-isbn 978-1-60327-864-5 DOI 10.1007/978-1-60327-864-5 Springer New York Dordrecht Heidelberg London Library of Congress Control Number: 2010936467 Springer Science+Business Media, LLC 2010 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. Printed on acid-free paper Springer is part of Springer Science + Business Media (www.springer.com)
Preface Female reproductive success relies upon coordinated interactions among the hypothalamus, the pituitary, and the ovaries and the subsequent hormonal priming of the endometrium for implantation. The absence of oocyte fertilization or the failure of embryo implantation results in ovarian hormone withdrawal, the onset of menses, and the beginning of the next reproductive cycle. Failure of any single organ in the quartet to play its part can result in amenorrhea. Although amenorrhea is a common problem that affects up to 10% of reproductive aged women, there has not been a major textbook solely dedicated to this clinical problem for more than 20 years. The main purpose of this first edition of Amenorrhea: A Case-Based Clinical Guide was to organize a comprehensive review that updates clinicians on our current knowledge regarding normal female reproductive physiology and to discuss the pathophysiology, diagnostic algorithms, and therapeutic intervention for amenorrhea. With this principal goal, we have invited several world experts on female reproductive physiology to provide clinicians with highly practical information regarding the epidemiology and management of amenorrhea. To that end, the content of this textbook has been divided into three sections; the first section is composed of two chapters that provide a comprehensive updated review on our basic science and clinical knowledge about the organ systems responsible for normal physiology of the menstrual cycle. This section focuses on the roles of the endometrium and the hypothalamic pituitary ovarian axis in the menstrual cycle. The second section includes discussions about menstrual cycle disruption as it relates to hypothalamic pituitary dysfunction, surgical and natural menopause, genetic defects, premature ovarian failure/insufficiency, and the effects of caloric excess and restriction. The third section of this book provides an update on the physiological effects of prolonged amenorrhea induced surgically or by hypothalamic dysfunction. The third section also includes an original chapter that focuses solely on the impact of race and ethnicity on the prevalence and diagnosis of amenorrhea. When appropriate, we have also created clinical scenarios and management plans that readers may be confronted with in their daily practice. v
vi Preface We would like to express our deep gratitude to our incredibly supportive administrative staff, Karen Knickens and Elizabeth Abbate, without whose determined efforts this project could not have been completed. We would also like to thank all of the contributors to this book for their diligence and outstanding efforts to update clinicians on the physiology of the menstrual cycle and pathophysiology and the clinical consequences of amenorrhea. We hope that the readers will find this book to be a complete resource for information regarding amenorrhea and that this book will be a well-used reference for doctors and other health professionals who care for women. Nanette F. Santoro and Genevieve Neal-Perry
Contents 1 The Hypothalamic-Pituitary-Ovarian Axis... Cary Dicken, Marie Menke, and Genevieve Neal-Perry 1 2 The Mechanism of Menstruation... Anjana R. Nair and Hugh S. Taylor 21 3 Amenorrhea Due to Idiopathic Hypogonadotropic Hypogonadism and Kallmann Syndrome... Lawrence C. Layman 35 4 Polycystic Ovary Syndrome... Enrico Carmina 45 5 Primary Ovarian Insufficiency... Amber R. Cooper, Sharon N. Covington, and Lawrence M. Nelson 55 6 Hyperprolactinemia and Pituitary Causes of Amenorrhea... Pouneh Fazeli and Lisa B. Nachtigall 83 7 Amenorrhea Associated With the Female Athlete Triad: Etiology, Diagnosis, and Treatment... 101 M.J. De Souza and R.J. Toombs 8 The Role of Body Weight in Menstrual Disturbances and Amenorrhea... 127 Alex J. Polotsky and Nanette Santoro 9 Natural and Surgical Menopause... 141 Sara Morelli and Gerson Weiss vii
viii Contents 10 Clinical Implications of Prolonged Hypothalamic Amenorrhea... 171 Tammy L. Loucks and Sarah L. Berga 11 Long-Term Implications of Oophorectomy at the Time of Hysterectomy for Benign Disease... 187 Donna Shoupe and Jonathan S. Berek 12 Ethnicity and Amenorrhea... 203 Benjamin M. Lannon and Kim L. Thornton Index... 213
Contributors Jonathan S. Berek MD, MMS Department of Obstetrics & Gynecology, Stanford University Hospital and Clinics, 300 Pasteur Drive Room HH333, Stanford, CA 94305-5317, USA Sarah L. Berga MD Department of Gynecology and Obstetrics, Emory University, 1639 Pierce Drive, Suite 4208-WMB, Atlanta, GA 30322, USA Enrico Carmina MD Department of Medical and Biological Sciences, University of Palermo, Via delle Croci 47, 90139 Palermo, Italy Amber R. Cooper MD Department of Obstetrics and Gynecology Division of Reproductive Endocrinology and Infertility, Washington University School of Medicine, St. Louis, MO, USA Sharon N. Covington MSW Integrative Reproductive Medicine Unit, Intramural Research Program on Reproductive and Adult Endocrinology, Eunice Kennedy Shriver National Institute of Child, Health and Development, Bethesda, MD, USA M.J. De Souza PhD Women s Health and Exercise Laboratory, Noll Laboratory, Department of Kinesiology, Penn State University, University Park, PA 16802, USA Cary Dicken MD Department of Gynecology and Obstetrics and Women s Health and, The Dominic Pupura Department of Neuroscience, Albert Einstein College of Medicine, Bronx NY, USA Pouneh Fazeli MD Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA ix
x Contributors Benjamin M. Lannon MD Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology and Reproductive Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA Lawrence Layman MD Section of Reproductive Endocrinology, Infertility, and Genetics, Department of Obstetrics and Gynecology, Developmental Neurobiology Program, Institute of Molecular Medicine and Genetics, Medical College of Georgia, Augusta, GA 30912-3360, USA Tammy L. Loucks MPH Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA Marie Menke MD Department of Gynecology and Obstetrics and Women s Health and The Dominic Pupura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY, USA Sara Morelli MD Department of Obstetrics, Gynecology and Women s Health, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA Lisa B. Nachtigall MD Neuroendocrine Clinical Center unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA Anjana R. Nair MD Department of Obstetrics and Gynecology, New York Downtown Hospital, New York, NY, USA Genevieve Neal-Perry MD, PhD Department of Gynecology and Obstetrics and Women s Health and Domnick Purpura Department of Neuroscience, Albert Einstein College of Medicine of Yeshiva University, Jack and Pearl Resnick Campus, 1211 Ullmann Building, 1300 Morris Park Avenue, Bronx, NY 10461, USA Lawrence M. Nelson MD Integrative Reproductive Medicine Unit, Intramural Research Program on Reproductive and Adult, Endocrinology, Eunice Kennedy Shriver National Institute of Child, Health and Development, Bethesda, MD, USA Alex J. Polotsky MD, MS Department of Obstetrics and Gynecology, University of Colorado Denver School of Medicine, Aurora, CO, USA Nanette Santoro MD Department of Obstetrics and Gynecology, University of Colorado Denver School of Medicine, Aurora, CO, USA
Contributors xi Donna Shoupe MD, MBA Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology after Division of Reproductive Endocrinology Keck School of Medicine, University of Southern California School of Medicine, Los Angeles, California Hugh S. Taylor MD Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA Kimberley Thornton MD Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology and Reproductive Biology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA, USA R.J. Toombs BSc Women s Health and Exercise Laboratory, Noll Laboratory, Department of Kinesiology, Penn State University, University Park, PA, USA Gerson Weiss MD Department of Obstetrics, Gynecology and Women s Health, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA