Evaluation of menopausal status among breast cancer patients with chemotherapy-induced amenorrhea

Objective： In patients with chemotherapy-induced amenorrhea （CIA）, the menopausal status is ambiguous anddifficult to evaluate. This study aimed to establish a discriminative model to predict and classify the menopausalstatus of breast cancer patients with CIA.Methods： This is a single center hospital-based study from 2013 to 2016. The menopausal age distribution andaccumulated incidence rate of CIA are described. Multivariate models were adjusted for established and potentialconfounding factors including age, serum concentration of estradiol （E2） and follicle-stimulating hormone （FSH）,feeding, pregnancy, parity, abortions, and body mass index （BMI）. The odds ratio （OR） and 95% confidenceinterval （95% CI） of different risk factors were estimated.Results： A total of 1,796 breast cancer patients were included in this study, among whom, 1,175 （65.42%） werepremenopausal patients and 621 （34.58%） were post-menopause patients. Five hundred and fifty patients wereincluded in CIA analysis, and a cumulative CIA rate of 81.64% was found in them. Age （OR： 1.856, 95% CI：1.732-1.990）, serum concentration of E2 （OR： 0.976, 95% CI： 0.972-0.980） and FSH （OR： 1.060, 95% CI：1.053-i.066）, and menarche age （OR： 1.074, 95% CI： 1.009-1.144） were found to be associated with the patients＇menopausal status. According to multivariate analysis, the discriminative model to predict the menopausal status isLogit （P）=-28.396＋0.536Age-0.014E2＋0.031FSH. The sensitivities for this model were higher than 85%, and itsspecificities were higher than 89%.Conclusions： The discriminative model obtained from this study for predicting menstrual state is important forpremenopausal patients with CIA. This model has high specificity and sensitivity and should be prudently used.

Amenorrhea as a rare drug-related adverse event associated with everolimus for pancreatic neuroendocrine tumors

The patient was an asymptomatic 43-year-old woman. Abdominal ultrasonography and enhanced computed tomography showed a tumor lesion accompanied by multiple cystic changes in the liver and the pancreatic tail. Endoscopic ultrasound-fine needle aspiration was performed on the pancreatic tumor lesion and revealed pancreatic neuroendocrine tumor(PNET). As it was unresectable due to multiple liver metastases, the decision was made to initiate treatment with everolimus and transcatheter arterial chemoembolization. The patient ceased menstruating after the start of everolimus administration. When the administration was discontinued due to interstitial lung disease, menstruation resumed, but then again stopped with everolimus resumption. An association between everolimus and amenorrhea was highly suspected. Amenorrhea occurred as a rare adverse event of everolimus. As the younger women might be included in PNETs patients, we should put this adverse event into consideration.

Cytogenetic and Clinical Analysis of 340 Chinese Patients with Primary Amenorrhea

Objective To analyze the relationship between karyotypes and clinic features of patients with primary amenorrhea.Methods G banding was done for 340 patients with primary amenorrhea to facilitate individual chromosome identification,and if specific staining for certain portions of the chromosome was necessary,C banding was used.The clinical data were recorded by physical examination and ultrasound scanning.Results Karyotype analysis of the 340 patients revealed that 180(52.94%) patients had normal female karyotypes and 160(47.06%) patients had abnormal karyotypes.The abnormal karyotypes included abnormal X chromosome(150 patients),mosaic X-Y chromosome(4 patients),abnormal autosome(5 patients),and X-autosome translocation(1 patient).The main clinical manifestations in patients with primary amenorrhea were primordial or absent uterus(95.9%),invisible secondary sex features(68.8%),little or absent ovary(62.6%),and short stature(30.0%).The incidence of short stature in patients with X chromosome aberration(46%,69/150) was significangly higher that in patients with 46,XX(9.44%,17/180) as well as 46,XY(6.67%,3/45;χ2=146.25,P=0.000).All primary amenorrhea patients with deletion or break-point at Xp11.1-11.4 were short statures.Conclusions One of the main reasons of primary amenorrhea is choromosome abnormality,especially heterosome abnormality.It implies the need to routinely screen chromosomal anomalies for such patients.There might be relationship between Xp11.1-11.4 integrity and height improvement.

CLINICAL OBSERVATION ON ACUPUNCTURE TREATMENT OF 47 CASES WITH SECONDARY AMENORRHEA

Cases of secondary amenorrhea were treated by acupuncture, and the rate ofrestoring menstruation is relatively high. The total effective rate was 77%. But the some diseasewhich may cause amenorrhea is difficult to treat, such as hypo-ovaria praecox, pituitary micro-adenoma. The acupuncture has clear curative effect during primary course treatment. The amenorrhea withlactorrhea syndrome by the high prolactin (PRL) in the serum is also able to be treated by usingacupuncture.

Study on Correlation between Neuropeptide and Functional Hypothalamic Amenorrhea

ve To explore the correlation between neuropeptide and functional hypothalam-ic amenorrhea(FHA)

Primary amenorrhea with transverse vaginal septum and scant hematocolpos: A case report

Background: A genital outflow tract obstruction is an uncommon cause of primary amenorrhea. If ovulation occurs, menstrual bleeding is prevented. Patients typically present with abdominal/pelvic pain due to hematocolpos. Absence of significant hematocolpos could indicate a secondary source of primary amenorrhea and be challenging to the clinical diagnosis. Case: 17 year-old patient with primary amenorrhea, appropriate Tanner staging secondary sex characteristics, and transverse vaginal septum presents with virtual absence of hematocolpos. After vaginal septum resection, the patient began menstruating, although only evidenced by two cycles of vaginal spotting. Conclusion: Significant hematocolpos is an expected sequella of distal outlet obstruction when collated with secondary sexual characteristics. Absence of such along with suboptimal return of menstruation reflects pathophysiology which may be attributed to a coexistent disorder of the hypothalamus or higher central nervous system function.

Resolution of Amenorrhea and Chronic Constipation in an Adult Patient with Idiopathic Scoliosis Wearing a Scoliosis Activity Suit for 6 Months: A Case Report

Objective: To report the symptomatic and radiographic changes in an adult scoliosis patient with a history of amenorrhea and chronic constipation. Clinical Features: Patient presented for treatment with an 8-year history of amenorrhea and chronic constipation. Radiographic study showed a right thoracic/left lumbar double major scoliosis. Intervention and Outcome: Patient was fitted for a scoliosis activity suit and given instructions for continued home use, building up to 3 - 4 hours total daily. After 6 months of use, her amenorrhea and chronic constipation had resolved, and both scoliosis Cobb angles also improved. Scores on before and after SRS-22r questionnaires, as well as a quadruple numerical pain rating scale, also improved. Conclusion: A patient wearing a scoliosis activity suit for 6 months reported symptomatic changes as well as radiographic, pain, and quality of life improvements. The results of this case cannot be generalized. More investigation into the association of scoliosis and other organic symptoms is warranted.

Chemotherapy Induced Amenorrhea in Women Treated with Chemotherapy for Breast Carcinoma in Yalgado Ouédraogo Teaching Hospital in Ouagadougou, Burkina Faso

Background: We conducted this study to identify factors associated with the onset and reversibility of chemotherapy-induced amenorrhea in Yalgado Ouédraogo Teaching Hospital of Ouagadougou. Methods: A historical cohort study was performed and covered the period from 1 January 2014 to 31 July 2015. No menopausal patients managed for a histologically confirmed breast carcinoma and having benefited from chemotherapy were included in the study. Logistic regression analysis was used to determine the factors associated with the occurrence of chemotherapy-induced amenorrhea as well as its reversibility. Results: Seventy patients were included. The mean age was 38.5 years. Thirteen patients were obese and 19 (40.4%) had their menarche after age of 15 years. Adjuvant chemotherapy was administered to 31 patients while 12 had received neoadjuvant chemotherapy. Sequential chemotherapy with an anthracycline and a taxanetherapeutic protocol was the most used. Forty-seven patients had a chemotherapy-induced amenorrhea. The risk of having a chemotherapy-induced amenorrhea increases by 25% for each additional year of age at diagnosis of cancer (p = 0.0001). Obesity and menarche after age 15 were found to be protective factors. After adjusting these variables together, age, obesity, and age at menarche were factors independently associated with the occurrence of the chemotherapy-induced amenorrhea. The reversibility was effective in 11 cases (37.9%) and especially concerned patients younger than 40 years (p = 0.03). Conclusion: Age is the primary risk factor. Reliable markers of ovarian function need to be developed to better select fertility conservation protocols.

Discussion on the treatment of amenorrhea by "Tihujiegai method"

"Tihujiegai method"(lifting a kettle and removing its lid figuratively refers to a method of lifting the'Lung Qi'(It refers to the functional activity of the lungs and also includes breathing gases.)to promote urination.),created by Zhu Danxi(1281-1358),who ranked among the era’s best doctors,is a metaphor for using"Xuanfei method"(A method of promoting the dispersing function of the lung)or"Tiqi method"(A method for treating Qi activity depression),which has been widely used later.The author consulted a large number of relevant essays and found that the"Tihujiegai method"of amenorrhea was also effective.This study mainly discusses the treatment of amenorrhea method theoretically,and opens up ideas for clinical application.

Cytogenetic analysis of patients with amenorrhea

Objective: To analyse the cytogenetic examination results and investigate the effect of chromosome abnormalities on amenorrhea.Methods: The routine cytogenetic analysis was performed, including the chromosome G band analysis and karyotype analysis of the cultured peripheral blood lymphocytes from the patients with primary amenorrhea or secondary amenorrhea.Results: One hundred and thirty-seven cases were found with chromosome abnormalities in 234 patients with primary amenorrhea. The incidence of chromosome abnormality was 58.6%. In 309 with secondary amenorrhea, the incidence of chromosome abnormality was 13.6%.The reported abnormalities included the numerical and structural abnormalities of X chromosome, 46,XY, 45,X0/46,XY,and the structural abnormality of autosome.Conclusions: Chromosome abnormality is one of the main causes of amenorrhea. Karyotype analysis of chromosome is absolutely necessary for the diagnosis and treatment of patient with amenorrhea.

Acupuncture and moxibustion for functional hypothalamic amenorrhea by establishing artificial cycle:a controlled trial

Objective To observe the clinical efficacy of acupuncture and moxibustion in treatment of functional amenorrhea by establishing artificial cycle.Method One hundred and twelve eligible patients with functional amenorrhea were divided into an acupuncture-moxibustion group（64 cases） and a western medication group（48 cases） by adopting random method.According to the pattern differentiation of amenorrhea of traditional Chinese medicine,the patients in the acupuncture-moxibustion group were classified into two types：amenorrhea due to blood depletion and amenorrhea due to stagnation of blood.For patients with amenorrhea due to blood depletion,Guanyuan（关元 CV4）,Zhongji（中极CV 3）,GuiTlai（归来ST 29）,Geshu（膈俞 BL 17）,Ganshu（肝俞BL 18）,Pishu（脾俞 BL 20） and Shenshu（肾俞 BL 23） were selected.At first,BL 17,BL 18,BL 20 and BL 23 were needled;after deqi,reinforcing method was applied,and the needles were not retained.Then,warmingneedle moxibustion was applied at CV 4,CV 3 and ST 29,and the needles were retained for 30 min.For patients with amenorrhea due to stagnation of blood,CV 3,Qihai（气海CV 6）,Xuehai（血海 SP 10）,Sanyinjiao（三阴交 SP 6）and Xingjian（行间 LR 2） were selected,reducing method was applied,and the needles were retained for 30 min.The treatment was performed once a day,and treatment for 15 consecutive days were the 1st cycle.The 2nd and3 rd cycles started from the 5th day of menstruation（for the patients still not menstruating,the 2nd and 3rd cycles started from the 29 th and 57 th days since the 1st day of treatment）,and the treatment lasted for 15 days.Three cycles were needed.In the western medicine group,estrogen-progestogen was taken orally for 21 days（one cycle） to establish a artificial cycle.The levels of FSH and LH were tested and compared on the 3rd day of menstruation before treatment and after the 3rd cycle of treatment,and the adverse effects were analyzed statistically.Follow-up visit was conducted for the patients after treatment for three cycles,and the recurrence rate was calculated.Result The levels of FSH and LH of patients with functional amenorrhea were enhanced significantly through establishing artificial cycle by acupuncture and moxibustion.There was no significant difference between the acupuncture-moxibustion group and the western medication group in effective rate（P〉0.05）;but the adverse effect rate（1.49%） and recurrence rate（25.0%） of the acupuncture-moxibustion group were lower than that of the western medication group（with the adverse effect rate of 4.14%,and recurrence rate of 69.8%）（both P〈0.05）.Conclusion The levels of FSH and LH of patients with functional amenorrhea can be enhanced significantly through establishing artificial cycle by acupuncture and moxibustion.The efficacy of acupuncture and moxibustion in treatment of functional amenorrhea by establishing artificial cycle is equivalent to that of oral administration of estrogen-progestogen in treatment of functional amenorrhea by establishing artificial cycle,but the adverse effect rate and recurrence rate of acupuncture and moxibustion group are lower.

磁共振成像在子宫及下生殖道先天发育异常致原发性闭经中的应用价值

目的探讨磁共振成像(MRI)对子宫及下生殖道先天发育异常所致原发性闭经的诊断价值。方法选取2015年11月至2023年5月就诊于首都医科大学附属北京妇产医院因先天发育异常导致原发性闭经的患者41例,回顾性分析其临床表现和MRI影像,总结影像学表现特点。结果结合临床表现和MRI表现,最终诊断先天性子宫阴道缺如(MRKH)综合征27例,雄激素不敏感综合征2例,处女膜闭锁6例,宫颈闭锁2例,阴道下段闭锁4例。27例MRKH综合征患者表现为子宫缺如或始基子宫,伴阴道部分闭锁19例、全程闭锁8例;2例雄激素不敏感综合征患者表现为子宫及宫颈缺如,阴道下段可见,1例性腺位于双侧腹股沟区,1例位于盆腔内髂外血管内侧并伴发肿瘤;6例处女膜闭锁患者表现为子宫腔、宫颈管及阴道全程不同程度积血,1例伴输卵管积血;2例宫颈闭锁患者同时合并阴道闭锁、输卵管积血;4例阴道下段闭锁患者表现为闭锁段上方阴道、宫颈管及宫腔增宽积血。结论MRI可清楚显示子宫及下生殖道发育异常,明确导致原发性闭经的病变部位,为患者下一步诊治提供可靠参考信息。

4例46,XY性发育障碍患者遗传学分析

目的:探讨4例46,XY性发育障碍发生的分子机制。方法:收集患者临床病历资料,采集其肝素抗凝外周血进行淋巴细胞培养,染色体G显带技术制备并分析染色体核型,提取外周血DNA行SRY基因检测和测序,SRY基因检测结果阴性者外送标本行性发育相关基因靶向测序,生物信息学方法分析测序结果。结果:查体显示4例患者社会性别均为女性,而外周血淋巴细胞核型分析结果提示核型均为男性(46,XY),社会性别与生物学性别不一致;性别决定基因SRY均为阳性,测序结果提示病例1为SRY基因编码区第5位碱基缺失(c.del5A),病例2为SRY基因编码区第5位碱基发生错义突变(c.5A>T),病例3为SRY基因编码区第6位碱基缺失(c.del6A),病例4的SRY基因检测范围内未见突变位点,靶向测序结果提示雄激素受体基因(AR)编码区发生错义突变(c.2117 A>G);生物信息学软件Mutation taster提示c.del5A、c.del6A和c.2117 A>G等3种突变可能导致疾病发生,c.5A>T突变可能为人群多态现象;Raptor X蛋白质三维结构预测软件分析结果显示SRY基因c.5A>T突变对SRY蛋白的三维构象没有影响,而AR基因c.2117 A>G突变可导致AR蛋白的三维结构明显变化,并增加两个氢键;PolyPhen-2显示SRY基因c.5A>T和AR基因c.2117A>G突变为可能致病;ClinvAR软件分析结果提示4种突变均未见临床病例报道。结论:基因突变可能是导致患者性器官发育异常的原因,基因检测有助于明确诊断以及家庭再生育咨询。

Clinical manifestations of low bone mass in amenorrhea patients with elevated follicular stimulating hormone

OBJECTIVE: To study the characteristics of low bone mass in amenorrhea patients with elevated follicular stimulating hormone (FSH). METHODS: Amenorrhea patients with elevated FSH: Primary amenorrhea 18 cases, secondary amenorrhea 171 cases and age matched controls with normal menstruation, 180 cases. The descriptive parameters were: estrogen, alkaline phosphatase, urinary excretion of calcium to creatine ratio, cortical bone mineral density at the right radius measured by single photon absorptiometry and trabecular bone mineral density at the lumbar vertebra body measured by quantitative computerized tomography. RESULTS: Average E(2) levels in amenorrhea patients is under 150 pmol/L with significantly higher alkaline phosphatase and urine calcium to creatine ratio values than the normal menstruation group. Cortical bone mineral density in the secondary amenorrhea group (655 +/- 69 mg/cm(2)) was significantly lower than that of the normal menstruation group (677 +/- 56 mg/cm(2), P

Late Diagnosis of Turner Syndrome in Adulthood;a Case Study from the Endocrinology-Diabetology Nutrition Department of the National Hospital of Pikine Senegal

Introduction: Turner syndrome is a rare genetic disorder characterised by the presence of one X chromosome and the absence of part or all of an X or Y chromosome and patients may experience delayed puberty and infertility. Our study aimed to evaluate the diagnostic delay in our practice and analyze the impact of this diagnostic delay on the effectiveness of patient management. Patients and Methods: Turner syndrome patients were identified from the endocrinology-diabetology nutrition department Database We examined the records of patients in whom the karyotype analysis favoured Turner syndrome. Results: We have selected 5 patients’ records of female patients with Turner syndrome. The mean age was 25, ranging from 19 to 29 years. Primary amenorrhea and characteristic dysmorphic features were observed in all patients. One married patient, who sought consultation for infertility, expressed a desire for pregnancy. Short stature was identified in 3 patients. Primary hypothyroidism and hypertension were respectively found in 1 and 2 patients. Gonadal dysgenesis was noted in 100% of cases. Karyotype analysis revealed monosomy X in 2 patients and mosaic patterns in others. All patients received estrogen-progestin treatment. Antihypertensive therapy was initiated for 2 patients. One patient is on L-thyroxine. In the short term, treatment led to the onset of menstruation after the initial months. Evaluation of treatment efficacy on internal genital organs is yet to be performed. Due to uncertain benefits at this age, growth hormone therapy was not considered for our patients. We provided counseling on assisted reproductive options for couples desiring to conceive. In our study, all patients were placed on estrogen-progestin therapy, and the response appeared favorable. Conclusion: In our practice, the diagnosis of Turner syndrome occurs very late in adulthood, at an age when growth hormone treatment is nearly ineffective. Treatment typically revolves around estrogen-progestin therapy, along with managing other comorbidities such as hypertension and primary hypothyroidism.

《医学衷中参西录》治女子不月用药特点探析:从药性角度

药性理论是中医的重要组成部分,通过对药性的准确认识,可有效指导组方用药。“女子不月”首见于《黄帝内经》,意指月事不来、闭经。通过从药性角度对《医学衷中参西录》中治疗女子不月诸方的用药特点进行分析,发现张锡纯治不月喜用性平之品,五味常用甘、苦、辛,以健脾益胃、活血通经;重视冲脉,归经与脾、胃、肺、肾、肝、心经均有关;承《神农本草经》之旨,对药物有独特见解,胜病为主,敢于用毒;药物配伍合理,升降相因,气机平衡。该研究可为治疗闭经临床用药提供思路。

《闭经诊断与治疗指南(2023版)》解读

闭经是临床常见的症状。由于其病因多样,包含各种生殖系统结构性异常、全身系统性疾病和内分泌功能紊乱,诊疗较复杂。2023年中华医学会妇产科学分会妇科内分泌学组发布了《闭经诊断与治疗指南》,该指南针对病理性闭经的定义、分类、发病机制、诊断、鉴别诊断与治疗进行了更新和补充,为闭经的精准诊断和治疗管理提供了相关建议。本文通过对《闭经诊断与治疗指南(2023)版》进行详细解读,重点分析闭经的诊断流程和生育相关问题的处理办法,使该指南更具有临床实践的指导意义,有助于闭经的规范化诊疗。

中药复方对抗精神病药物所致女性精神分裂症患者闭经的疗效的Meta分析

背景 精神疾病发病率不断升高,而抗精神病药物容易引发女性患者药源性闭经,使患者服药依从性降低,疾病复发率增高。改善药物引起的女性患者闭经问题成为一个亟需解决的问题。目的 探讨中药复方治疗抗精神病药物所致闭经的效果和安全性,为中药复方治疗抗精神病药物所致闭经提供参考。方法 于2022年9月4日,计算机检索中国知网、维普数据库、万方数据库、中国生物医学文献数据库、PubMed、Cochrane Library、Embase,收集中药复方治疗抗精神病药物所致闭经的随机对照试验(RCT)。采用Cochrane 5.3偏倚风险评估工具对纳入文献进行质量评价。采用RevMan 5.3对中药复方治疗抗精神病药物所致闭经的总有效率、治愈率、不良反应发生率和复发率进行Meta分析。结果 最终纳入22项RCT研究,包括1 879例患者。Meta分析结果显示,中药复方或中药复方联合西药治疗抗精神病药物所致闭经的总有效率(RR=1.29,95%CI:1.16~1.44)及治愈率(RR=1.62,95%CI:1.45~1.80)均高于单纯西药治疗,不良反应发生率(RR=0.56,95%CI:0.41~0.76)和复发率(RR=0.16,95%CI:0.06~0.42)均低于单纯西药治疗。结论 中药复方可能有助于改善抗精神病药物所致的闭经,且安全性优于单纯西药治疗。

中枢性闭经患者代谢性指标的相关关系研究

目的探讨中枢性闭经患者代谢性指标异常的发生率,代谢异常指标和高同型半胱氨酸血症(HHcy)、糖代谢异常的相关关系。方法回顾性分析2021年12月1日至2022年6月1日太原市妇幼保健院生殖内分泌科门诊中枢性闭经患者60例为研究对象,同期检查的健康妇女60名,年龄14~40岁。进行血压测量、人体成分分析,并测定甲状腺功能、同型半胱氨酸(Hcy)、尿酸、肝功能、肾功能、血脂以及糖耐量试验和胰岛素释放试验。比较分析60例中枢性闭经患者代谢性指标异常的发生率,同时代谢性指标与Hcy及糖代谢具有相关性。结果中枢性闭经组患者与健康对照组相比,HHcy(87%与57%)、糖代谢异常(93%与50%)、总胆固醇(30%与13%)、三酰甘油(37%与8%)及高密度脂蛋白胆固醇(40%与17%)异常的发生率明显升高,差异有统计学意义(P<0.05);在中枢性闭经与多种因素的相关关系分析中,表明中枢性闭经的危险因素为糖代谢异常的发生、HHcy及高三酰甘油血症。结论中枢性闭经患者是HHcy、糖代谢异常及高脂血症发生的高危人群,建议对于中枢性闭经的患者要常规行Hcy、糖代谢及血脂等代谢性指标的检查,对指导综合治疗有重要意义。

基于一气周流理论浅析逍遥散治疗闭经

黄元御一气周流理论以“中土为轴,四象为轮”为基本框架结构,将人体生理病理与“土枢四象”的周流运转联系起来,为中医临床诊治疾病提供一种新的思路。逍遥散源自《太平惠民和剂局方》,在妇科病闭经的临床治疗方面起到了很好的效果,其方药组成可通过升木达郁、培补土气来恢复“一气周流”,而改善闭经“木气郁陷、中土气虚”的病机,恢复月经来潮。