Clinical masks of secondary amenorrhea: treatment of the disease rather than its symptom


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Abstract

The review provides relevant data on the prevalence and structure of the causes of secondary oligo- and amenorrheas. It substantiates a diagnostic search algorithm in women with secondary oligo- or amenorrheas. The authors have presented the main diagnostic pitfalls that a clinician may face when consulting patients with menstrual cycle disorders. The paper gives the modern therapeutic strategies developed by Russian and international professional communities, which are aimed at eliminating oligo- and amenorrheas in various endocrinopathies that are within the competence of an obstetrician/gynecologist. The authors have systematized therapeutic approaches to correcting menstrual irregularities in women with anovulatory infertility, depending on the verified diagnosis. The article discusses the main strategy mistakes in the management of premature ovarian failure, polycystic ovary syndrome, and functional hypothalamic amenorrhea, which may be made in real clinical practice. Thus, the most commonly used combined hormonal contraceptives (CHCs) for the correction of menstrual cycle disorders in some cases are only able to mask serious diseases, such as premature ovarian failure and functional hypothalamic amenorrhea, in which the first-line therapy of choice is bioidentical rather than synthetic, transdermal estrogens (for example, as a patch, 0.1% estradiol gel, and others) in combination with progestins. With the CHC-created illusion of uninterrupted functioning of all parts of the hypothalamic-pituitary-ovarian axis, individual endocrinopathies can progress to irreversible consequences, for example, as complete depletion of the ovulatory reserve in women with unrealized reproductive plans or to an episode of low-energy fracture. Conclusion. The verification of a disease manifested by secondary oligo- or amenorrhea requires clear and consistent diagnostic measures combined in the algorithm proposed by the authors. The timely and correct differential diagnosis of various endocrinopathies will be able to develop etiotropic and pathogenetic treatment for a specific nosological entity, and not just to eliminate a disease symptom.

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About the authors

Karina R. Bondarenko

N.I. Pirogov Russian National Research Medical University, Ministry of Health of the Russian Federation

Email: karinabond@mail.ru
MD, PhD, associate professor of the Department of Obstetrics and Gynecology, Therapeutic faculty Moscow, Russia

Yulia E. Dobrokhotova

N.I. Pirogov Russian National Research Medical University, Ministry of Health of the Russian Federation

Email: pr.dobrohotova@mail.ru
MD, PhD, professor of the Department of Obstetrics and Gynecology, Therapeutic faculty Moscow, Russia

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