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Clinical Manifestations Of Ovarian Hormonal Disorders: Polycystic Ovary Syndrome And Medical Problem Of Menopause

Updated on February 17, 2014

Polycystic Ovary Syndrome

This is a heterogenous disorder clinically characterized by ovulatory failure, hirsuitism, obesity and infertility. The ovaries are enlarged, multicystic and they show hyperplastic theca cells around the cysts.
This is a heterogenous disorder clinically characterized by ovulatory failure, hirsuitism, obesity and infertility. The ovaries are enlarged, multicystic and they show hyperplastic theca cells around the cysts. | Source

Polycyctic Ovary Syndrome

The incidence of Polycystic Ovary syndrome globally which is in an increase is of huge significance to global health. Also understanding the period of menopause helps women prepare and adapt well to it.

Polycyctic Ovary Syndrome

This is a heterogenous disorder clinically characterized by ovulatory failure, hirsuitism, obesity and infertility. The ovaries are enlarged, multicystic and they show hyperplastic theca cells around the cysts. Only very small amounts of estradiol are produced by the immature follicles. Excessive amounts of androgens are produced by the hyperplastic theca cells and stromal cells. The enlarged cystic ovaries on both sides can be made out by bimanual examination of diagnostic laparoscopy. Therapeutic measures are designed to restore fertility, normalize menstruation and reverse hirsuitism.

Dysfunctional uterine bleeding: Excessive or more frequent menstrual bleeding resulting from functional disturbances, but without obvious pathological causes is called dysfunctional uterine bleeding. Hormonal imbalance and nutritional, psychologic and hematologic factors play contributory roles. This is a common gynecological problem in women in the fourth and fifth decades of life.

Medical Problem Of Menopause

Women attain menopause usually between 40 and 47 years. Menopause is taken to be complete when a women has not had periods for one year in the absence of any pathological condition or obvious features of ovarian deficiency.

Physiological changes: Menopause represents a form of primary ovarian failure. The number of ovarian follicles steadily decline with age and these follicles become less and less sensitive to the action of FSH as age advances, as women reach menopause, the FSH/LH reach high levels and the estrogen levels fall and because of diminishing number of follicles in the ovary production of estrogen is reduced. In many subjects, the development of menopause may be quite uneventful and asymptomatic. The following four groups of symptoms may develop in those who become symptomatic.

General symptoms: These include insomnia, nervousness, anxiety, depression, irritability, headache, dizziness and joint pains.

Vasomotor symptoms: These consist of hot flushes, inappropriate perspiration and palpitation. These occur frequently as sudden burning feeling all over the body followed by sweating, faintness and palpitation. Sometimes, these symptoms are very frequent and disabling.

Atrophic Changes in the genitalia: The main symptoms are urinary stress incontinence, vaginal atrophy, irritant vaginal discharge, dryness, dyspareunia, vulvar pruritus, and/or burning.

Cosmetic effects: Certain characteristic changes include the development of fine folds and marks radiating from the mouth, sagging of the infra-orbital fold of skin on the face, sagging and atrophy of the breasts and generalized wasting of adipose tissue. Osteoporosis is common and this may lead to fractures of the vertebrae and limbs.

Menopause

menstrual-cycle-menopause
menstrual-cycle-menopause | Source

Management

In troublesome cases, estrogen supplementation is instituted. Definite indications for estrogen therapy are: hot flushes, dyspareunia, cosmetic disability and osteoporosis.

Several Preparations Of Estrogens Are Used In The Therapy Of Various Disorders

 
Preparation
Routine Of Administration
Dose
Natural
Estradiol
Parenteral (s/c)
0.4 mg
 
Estrone sulphate
Oral
0.4 mg
Semi synthetic
Ethinyl estradiol
Oral
0.01 to 0.05 mg
Synthetic
Stillbesterol
Oral
0.01 to 1 mg
 
Dienoesterol
Oral
4 mg
 
Methallenestrol
Oral
12 to 24 mg
 
Chlorotrianisine
Oral
12 to 24 mg
 
Mestranol
Oral
Oral contraceptive
 
Fosfestrol (Honvan)
Oral and parenteral
100 to 250 mg used to treat prostatic carcinoma

Estrogens are given orally in cycles of three weeks followed by a free interval for one week. In those cases with intact uterus, progestogens are employed in the third week. Estrogen therapy is absolutely contraindicated in those with cerebrovascular accidents, recent myocardial infarction, carcinoma of breast, pancreatitis, cholecystitis, endometrial carcinoma and recurrent venous thromboembolism. Relative contraindications include cystic disease of the breasts, heavy smoking, hypertension, family history of carcinoma of the breast, liver diseases, cholelithiasis, diabetes mellitus, endometrial hyperplasia, gross obesity and a single episode of thrombophlebitis.

© 2014 Funom Theophilus Makama

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