RT Book, Section A1 Cheang, Kai I. A1 Umland, Elena M. A2 DiPiro, Joseph T. A2 Yee, Gary C. A2 Posey, L. Michael A2 Haines, Stuart T. A2 Nolin, Thomas D. A2 Ellingrod, Vicki SR Print(0) ID 1182462569 T1 Menstruation-Related Disorders T2 Pharmacotherapy: A Pathophysiologic Approach, 11e YR 2020 FD 2020 PB McGraw-Hill Education PP New York, NY SN 9781260116816 LK accesspharmacy.mhmedical.com/content.aspx?aid=1182462569 RD 2024/03/29 AB KEY CONCEPTS While a urine pregnancy test should be one of the first steps in evaluating amenorrhea, the majority of primary amenorrhea case 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, if correction of the underlying cause does not restore menses, estrogen (with a progestin) is recommended. Heavy menstrual bleeding (HMB) is generally caused by either uterine structural abnormalities or nonstructural causes. Pregnancy, including intrauterine pregnancy, ectopic pregnancy, and miscarriage, must be at the top of the differential diagnosis for any woman presenting with heavy menses. When compared to other conventional medical therapies used for HMB, the levonorgestrel intrauterine system is associated with a 61% lower discontinuation rate and 82% fewer treatment failures. Intrauterine systems (IUS) or devices are considered therapeutic options in a variety of menstruation-related disorders. Guidelines from the American College of Obstetricians and Gynecologists (ACOG) indicate that both nulliparous and multiparous women 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. Although its exact definition continues to evolve, 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 adult women and adolescents with PCOS. The selective serotonin reuptake inhibitors (SSRIs) are first-line pharmacologic treatment options for premenstrual dysphoric disorder (PMDD).