Epidemiology The age of menopause has been constant over several centuries and is influenced by genetic, ethnic, and environmental variables. The prediction of the age of menopause based on antimüllerian hormone (AMH) trajectories is possible but impractical. Menopause is defined…
Key points For in vitro fertilization (IVF) with and without intracytoplasmic sperm injection, the delivery rate per cycle in which ova are retrieved is as high as 50%, depending on the age of the woman. The rate of pregnancy after…
Key points Infertility is considered to be a disease and affects approximately 7% of all U.S. couples of reproductive age—more than 7 million women in the United States. A systematic evaluation of factors involved in infertility should be carried out…
Key points Polycystic ovary syndrome (PCOS) is now diagnosed by the Rotterdam criteria, which are clinical end points, and is not a laboratory diagnosis . The diagnosis requires finding any two of the following: menstrual irregularity, hyperandrogenism (clinical or biochemical),…
Key points The major androgen produced by the ovaries is testosterone and that of the adrenal glands is dehydroepiandrosterone sulfate; many potent 11-oxo androgens produced by the adrenal glands determine androgen action but are not currently measured. Androgen action is…
Key points The main symptoms of hyperprolactinemia are galactorrhea and amenorrhea, the latter caused by alterations in normal gonadotropin-releasing hormone release. Pathologic causes of hyperprolactinemia include pharmacologic agents, hypothyroidism, chronic renal disease, chronic neurostimulation of the breast, hypothalamic disease, and…
Key points Primary amenorrhea is diagnosed if no menstrual function has occurred by age 15, or 5 years after initial breast development. Menarche is delayed approximately 0.4 year for each year of premenarchal athletic training. Gonadal failure is the most…
Key points The mean amount of menstrual blood loss in one cycle is approximately 35 mL but may be as much as 60 mL, with an average loss of 13 mg of iron. Heavy menstrual bleeding occurs in 9% to…
Key points Endometriosis is a benign, usually progressive, and sometimes recurrent disease that invades locally and disseminates widely. Causes include retrograde menstruation, coelomic metaplasia, vascular metastasis, immunologic changes, iatrogenic dissemination, and a genetic predisposition. Endometriosis lesions produce estrogen locally and…
Key points The rate of ectopic pregnancy in the United States has remained fairly constant since the early 2000s and is approximately 6.6 in 1000 pregnancies in women aged 15 to 24. Risks of ectopic pregnancy include age, smoking, pelvic…