Anovulation requires a complex medical management and this condition entails plenty of possible approaches. The currant physician must take into consideration each patient’s particular and complicated pathology, her medical history, symptoms and diagnosis.
Fortunately anovulation is not a medical condition which threatens the patient’s immediate health, and the physician has a possibility to diagnose accurately the underlying anatomic disorder which triggers this medical condition. But in spite of the large range of possible treatments available in the modern medicine, there have often appeared inadequate diagnosis and unsuccessfully treated cases, which indicates that this medical condition is far more complex that it would actually seem.
The particular care of the patients has to be understood by encompassing the individual symptoms’ analysis with the diagnosis of the various diseases which can lead to anovulation.
All the possibilities have to be taken into consideration and the physician must always consult with other specialist in order to rule-out all the possibilities.
In the pathology of the reproductive system we face different anovulation secondary complications, and the first of them is acute bleeding: caused by an abnormal uterine response to the administration of oral or intravenous estrogen. In this case the treatment consists in the administration of estrogen –Premarin- 25 mg IV q4h through the parenteral route in order to accelerate mitosis at the endometrial level. If in 12 up to 16 hours there is no positive response curettage and suction dilatation follow.
Birth control pills in a shock dose (200 mcg/d estrogen for a week) and then post-treatment administration of oral contraceptives for at least three month is used in the cases of not abundant bleeding to reestablish the normal endometrium.
Secondary amenorrhea involves along the routine pregnancy test, other studies which measure other blood parameters- the thyroidal functions, the blood prolactin and gonadotropine levels. After these tests a progestational challenge follows to help the doctor evaluate the patient’s endometrial lining and to diagnose a potential hypo-estrogenic state. In this case the treatment focuses on adding progesterone in order to prevent hyperplasia.
If the levels of prolactin or thyroid stimulating hormone-TSH- are above normal, medication has to correct the primary issue and, in this particular case ovulation is restored without additional intervention.
If the patient has been diagnosed with gonadotropin levels below normal (hypergonadotropic hypogonadism) the physician must assume that the underlying problem is found in the hypothalamic suspension or in space-occupying lesions caused by excessive exercise or brusque weight fluctuations.
Moreover if the systemic problem leys in the elevated follicle-stimulating hormone-FSH of luteinizing hormone –HL levels, hypergonadotropic hypogonadism; the doctor may presume ovary failure, condition related to the lack of inhibitory signals that in normal conditions come from the ovary.
The presence of hypoestrogenism can also be signaled by vaginal dryness, emotional instability and vasomotor spasms which cause hot flushes. If the occurrence of this condition manifests itself before the age of 30, the physician must analyze the patient’s karyotype in order to rule out any possible genetic abnormality like X premutation, or Y presence; moreover the physician must identify the presence of malignant germ tumors and pay special attention to possible autoimmune infections which can cause permanent damage to the ovarian tissue.