summary referat
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Summary
All evaluations for amenorrhea should begin with a pregnancy test. If abdominal pain
is present, ectopic pregnancy should be considered. Patients should be questioned about
contraceptive use, because extended-cycle combined Oral Contraceptions, injectable
medroxyprogesterone acetate (Depo-Provera), implantable etonogestrel (Implanon), and
levonorgestrel-releasing intrauterine devices (Mirena) may cause amenorrhea.(1)
Treatment of functional hypothalamic amenorrhea involves nutritional rehabilitation
as well as reductions in stress and exercise levels. Menses typically return after correction of
the underlying nutritional deficit.(1)
For women with hypothalamic amenorrhea who desire pregnancy, ovulation induction
with pulsatile GnRH or injectable gonadotropins is the treatment of choice. By leptin
replacement resulted in recovery of menstruation and corrected the abnormalities in the
gonadal, thyroid, growth hormone, and adrenal axes, but in bone metabolism, there is no
change in bone mineral density. It proved to correct leptin deficiency resulted in restoration
menes and ovulatory.
Administration of oestrogens and progestagens in the form of oestroprogestagen (EP)
therapy is the standard management to stimulate regular menses and also results in the
normalisation of bone mineral density. For bone loss, we can also give combination theraphy
such as calcium, vitamin D to recovery BMD, and combined with EP theraphy, it will results
maximum effective to recover BMD.
Cognitive behavioral therapy improved in women with hypothalamic amenorrhea
which caused by stress or psycopathologic problems. It can returned most woman ovulation
in observational group.