Ovarian dysfunction is an abnormal, irregular or absent ovulation. The menstrual bleeding is often irregular or absent. The diagnosis can usually create through the history of, or can be confirmed by measuring hormone levels or repeated pelvic sonography. The therapy consists mostly of ovulation induction with clomiphene or other drugs.

Ovarian dysfunction is an abnormal, irregular or absent ovulation. The menstrual bleeding is often irregular or absent. The diagnosis can usually create through the history of, or can be confirmed by measuring hormone levels or repeated pelvic sonography. The therapy consists mostly of ovulation induction with clomiphene or other drugs. Etiology Chronic ovulatory dysfunction in premenopausal women is most commonly caused by polycystic ovary syndrome (PCOS) But she has many other causes, including hyperprolactinemia Hypothalamic dysfunction Other diseases that cause anovulatory amenorrhea (see table (eg hypothalamic amenorrhea.): Causes of anovulatory amenorrhea) symptoms and discomfort ovarian dysfunction must be accepted if menstrual bleeding missing, irregularly occurring or will not be announced by symptoms such as tightness of the chest, bloated abdomen or mood swings. Diagnosis bleeding history Occasionally monitoring of basal body temperature determination of hormones in urine or serum or sonography A anovulation is often evident on the basis of bleeding history. The daily measurement of morning temperature can help identify if and when ovulation occurs. However, this method is often inaccurate and involves a margin of error of 2 days. More accurate methods are test kits for home, that an increase in the urinary excretion of luteinizing hormone (LH) 24-36 hours prior to ovulation (requires daily measurements over several days around the middle of the cycle around, usually starting at about or after 9. Show your cycle). Pelvic ultrasonography ,, to monitor the diameter of the ovarian follicles and rupture (and should be started in the late follicular phase measurement of serum progesterone and pregnanediol (metabolite of progesterone in the urine) serum progesterone levels ? 3 ng / ml ( ? 9.75 nmol / l) or elevated levels of Pregnandiolglukuronid (if possible, measured 1 week before the beginning of the next menstrual bleeding) confirm that ovulation has occurred. Intermittent or absent ovulation, should for evaluation of diseases of the pituitary gland, the hypothalamus or cause the ovaries (z. B. PCO). clomiphene or letrozole treatment may metformin in a body mass index ? 35 gonadotropins in ovulation Clomifenversagen the kan n are normally induced by drugs. Clomifene Usually, chronic anovulation, which is not caused by a hyperprolactinemia, primarily treated with the antiestrogen clomiphene citrate. Clomiphene is most effective in PCOS as the cause. Between the 3rd and 5th day after onset of bleeding clomiphene is 50 mg p.o. started 1 times / day; the bleeding may have used spontaneous or induced (e., by decrease of progesterone). Clomiphene is continued five days. Ovulation occurs then usually 5-10 days (mean 7 days) after the last Clomifendosis. When it comes to ovulation, followed by bleeding within 35 days after inducing menstruation. Depending on how much is needed for ovulation induction, the daily dose / dose may be increased at each cycle by up to 50 mg up to a maximum of 200 mg. If desired, the treatment for up to 4 ovulatory cycles will continue. In 75-80% of patients treated with clomiphene women there is an ovulation, but the pregnancy rate is not more than 40-50%. The unwanted side effects of clomiphene vasomotor flushing (10%), abdominal distension (6%), tension belong to the chest (2%), nausea (3%), visual disturbance (1-2%) and headache (1-2%) , A multiple pregnancy (twins primarily) occurs in approximately 5% and ovarian hyperstimulation syndrome in ? 1% of cases. Ovarian cysts are common. An early assumed association between the use of> 12 Clomifenzyklen and the incidence of ovarian cancer has not been confirmed. Clomiphene should not be given to women who are pregnant because it can theoretically genital birth defects verursachen.Letrozol Nachweise1 indicates that in obese women with PCOS, letrozole (an aromatase inhibitor) likely induced ovulation than clomiphene. The latest data show that this effect may also occur in thin women with PCOS. There is no evidence that letrozole is more effective than clomiphene for causes of Anovulationandere except for PCOS. With letrozole as Clomophen started between the 3rd and 5th day after the onset of bleeding. First, women are 2.5 mg po once / day for 5 days. If ovulation does not occur, the dose of 2.5 mg per cycle can be increased to a maximum of 7.5 mg / dose. The most common adverse effects of letrozole include fatigue and dizziness. Letrozole should not be given to women who are pregnant because it can theoretically cause genital birth defects. 1Legro RS, Brzyski RG, Diamond MP, et al: Letrozole versus clomiphene for infertility in the polycystic ovary syndrome. N Engl J Med 371: 119-129, 2014. metformin for women with PCOS may metformin (750-1000 mg po 2 times / day) may be a useful addition to ovulation, especially in the frequently occurring in PCOS patients insulin resistance. However, clomiphene alone is more effective than metformin alone and as effective as metformin and clomiphene together. Metformin can be helpful with a body mass index> 35 in women and should in women with PCOS and glucose intolerance consider werden.Menschliche gonadotropins For all women with ovarian dysfunction that is not to clomiphene (or letrozole, if used) appeal can human gonadotropin (ie, a preparation of purified or recombinant follicle-stimulating hormone [FSH] and varying amounts of LH contains) are employed. Several i.m. and s.c. administered drugs with a similar efficacy profile in trade; they typically contain 75 I.U. FSH activity with or without LH activity. They are usually given 1 time / day starting on the 3rd-5th Day induced or spontaneous bleeding. Ideally, they stimulate the maturation of 1-3 follicles that are documented within 7-14 days sonographically. After the follicle maturation, ovulation with human chorionic gonadotropin (hCG) is 5,000-10,000 I.U. in the. triggered. The criteria for use of hCG vary, but usually at least 1 follicles should be> 16 mm in diameter. Ovulation is not triggered when the patient is for a high risk of suffering a multiple pregnancy or ovarian hyperstimulation syndrome. Risk factors for these problems are the presence of> 3 follicles> 16 mm in diameter Pre-ovulatory serum estradiol level> 1500 pg / ml or> 1000 pg / ml in women with multiple small ovarian follicles. When correctly applied exogenous gonadotropins occurs in> 95% of women treated to ovulation, but the pregnancy rate is only 50-75%. After treatment with gonadotropins 10-30% of successful pregnancies are multiple pregnancies. Ovarian hyperstimulation syndrome occurs in 10-20% of cases; the ovaries can thereby be increased massively, and a life-threatening ascites and hypovolemia by the passage of the intravascular fluid volume in the peritoneal cavity can develop. (See also the guideline of the American Society for Reproductive Medicine Ovarian hyperstimulation syndrome.) Treatment of the underlying disorder Underlying diseases (eg. As hyperprolactinemia) must be treated. If the cause is a hypothalamic amenorrhea, can with Gonadorelinacetat, a synthetic gonadotropin releasing hormone (GnRH), which as pulsatile i.v. Infusion is given ovulation can be triggered. The most effective bolus doses ranging from 2.5 to 5.0 micrograms (pulse dose) regularly every 60-90 minutes. Under Gonadorelinacetat multiple pregnancy is unlikely. Since gonadorelin is no longer available in the US, clomiphene citrate is the preferred drug for treating hypothalamic amenorrhea, followed by exogenous gonadotropins when ovulation is unsuccessful.

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