TY  - CHAP
M1  - Book, Section
TI  - Menstrual-Related Disorders
A1  - Vest, Kathleen
A1  - Mayer, Danielle
A2  - DiPiro, Joseph T.
A2  - Yee, Gary C.
A2  - Haines, Stuart T.
A2  - Nolin, Thomas D.
A2  - Ellingrod, Vicki L.
A2  - Posey, L. Michael
PY  - 2023
T2  - DiPiro’s Pharmacotherapy: A Pathophysiologic Approach, 12th Edition
AB  - KEY  CONCEPTS  A  urine  pregnancy  test  should  be  one  of  the  first  steps  in  evaluating  amenorrhea;  however,  the  majority  of  primary  amenorrhea  cases  can  be  attributed  to  either  physical  anomalies  of  the  gonads,  outflow  tract,  or  anomalies  of  the  hypothalamic–pituitary–ovarian  (HPO)  axis.  For  hypoestrogenic  conditions  associated  with  primary  and  secondary  amenorrhea,  estrogen  (with  a  progestin)  is  recommended  if  correction  of  the  underlying  cause  does  not  restore  menses.  Heavy  menstrual  bleeding  (HMB)  is  generally  caused  by  either  uterine  structural  abnormalities  or  nonstructural  causes.  Pregnancy,  including  intrauterine  pregnancy,  ectopic  pregnancy,  and  miscarriage,  is  at  the  top  of  the  differential  diagnosis  for  any  person  presenting  with  heavy  menses.  The  levonorgestrel  intrauterine  system  (IUS)  is  associated  with  a  61%  lower  discontinuation  rate  and  82%  fewer  treatment  failures  when  compared  to  other  conventional  pharmacotherapies  for  HMB.  Intrauterine  devices  (IUD)  or  IUS  are  considered  therapeutic  options  in  a  variety  of  menstruation-related  disorders.  The  American  College  of  Obstetricians  and  Gynecologists  (ACOG)  guidelines  indicate  that  both  nulliparous  and  multiparous  females  at  low  risk  of  sexually  transmitted  diseases  are  good  candidates  for  IUS  use.  Abnormal  uterine  bleeding  associated  with  ovulatory  dysfunction  (AUB-O)  is  caused  by  oligo-  or  anovulation,  leading  to  irregular,  heavy  menstrual  bleeding  due  to  chronic  unopposed  estrogen  on  the  endometrium.  Polycystic  ovary  syndrome  (PCOS)  can  present  as  AUB-O,  and  symptoms  include  amenorrhea,  oligomenorrhea,  intermenstrual  bleeding,  and  HMB.  Its  exact  definition  continues  to  evolve,  but  it  is  a  disorder  of  androgen  excess  accompanied  by  ovulatory  dysfunction  and/or  polycystic  ovarian  morphology.  Insulin  resistance  is  often  present,  and  PCOS  is  a  risk  factor  for  the  metabolic  syndrome,  type  2  diabetes,  dyslipidemia,  hypertension,  and  possibly  cardiovascular  disease.  Combined  hormonal  contraceptives  (CHCs)  alone  should  be  recommended  for  the  management  of  irregular  menstrual  cycles  and  clinical  hyperandrogenism  in  adults  and  adolescents  with  PCOS.  The  selective  serotonin  reuptake  inhibitors  (SSRIs)  are  first-line  pharmacologic  treatment  options  for  premenstrual  dysphoric  disorder  (PMDD).  
SN  - 
PB  - McGraw Hill
CY  - New York, NY
Y2  - 2024/04/23
UR  - accesspharmacy.mhmedical.com/content.aspx?aid=1201556881
ER  -