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Tuberculosis (TB) of the genital tract presenting with secondary amenorrhoea

Abdul Mulalek N, Wan Abas WR, Muhammad Tamyez F, Ramli R

BMJ Case Rep, 2023 Dec 18;16(12).
PMID: 38110342 DOI: 10.1136/bcr-2023-258548
Matched MeSH terms: Amenorrhea/etiology
Fulltext Cytogenetic studies in women with primary amenorrhea

Ten SK, Chin YM, Noor PJ, Hassan K

Singapore Med J, 1990 Aug;31(4):355-9.
PMID: 2255934

Cytogenetic investigations were carried out on 117 women with primary amenorrhea who had been referred to our Genetics Laboratory by clinicians throughout Malaysia, after exclusion of other causes of the disorder. Thirty-six cases (31%) showed numerical or structural abnormalities of the sex chromosomes. These can be broadly classified into 4 main types, namely, presence of a Y chromosome (14%), X-chromosome aneuploidies (8%), structural anomalies of the X-chromosome (7%) and lastly, presence of a marker chromosome (2%). Mosaics constituted 17% of the abnormalities observed, always in association with a 45,X cell line. There was no observable correlation between the phenotype of the patients and their respective abnormal karyotypes. The aetiological role of sex chromosomal abnormalities in these amenorrheic women is discussed.

Matched MeSH terms: Amenorrhea/complications; Amenorrhea/genetics*
Current status of oral contraceptive

Ping WW, Puvan IS

Med J Malaysia, 1976 Mar;30(3):173-7.
PMID: 822261
Matched MeSH terms: Amenorrhea/chemically induced
Idiopathic Addison's disease

Ang GS, Da Costa JL

Med J Malaya, 1971 Dec;26(2):137-8.
PMID: 4260861
Matched MeSH terms: Amenorrhea/complications*
Fulltext Anorexia Nervosa in Schizophrenia: a starving mind within a susceptible brain

Nik Ruzyanei, N.J., Wan Salwina, W.I., Choo, S.P., Rosdinom, R.

Malaysian Journal of Psychiatry, 2011;20(1):1-5.
MyJurnal

Schizophrenia poses challenges in diagnosis and treatment strategies when the predominant clinical features represent another spectrum of disorder like eating disorders. Nevertheless, symptoms of eating disorder in schizophrenia are not entirely uncommon although never included in the diagnostic criteria. We reported a case of a woman who first presented at seventeen years old with food refusal and underlying psychosis resulting in severe weight loss, but defaulted treatment for almost a decade. In 2009, she presented again with sinus bradycardia and secondary amenorrhoea. In this report, we discussed about the patient’s vulnerability for psychosis and its psychodynamic drive which led to a complex symptoms manifestation. Our aim is to highlight its diagnostic dilemma and suggestions to treatment strategies unique to this presentation.

Matched MeSH terms: Amenorrhea
Women With Amenorrhea and Men With Menstruation: The Qualitative Experiences of People With Disorders of Sex Development in Nigeria

Sani AM, Arif II, Arshad MM, Mungadi IA, Soh KG, Soh KL

J Nurs Res, 2020 Feb;28(1):e67.
PMID: 30855517 DOI: 10.1097/jnr.0000000000000313

BACKGROUND: Disorders of sex development (DSD) affect the quality of life of people who live with this condition. In developing countries, diagnoses of DSD are associated with a delay in presentation until the patients developed ambiguous physical traits and features.
PURPOSE: This study explores the menstrual experiences of people with DSD and sex reassignment in Nigeria.
METHODS: A qualitative approach with a phenomenological study design was employed in this study to explore and describe the experiences of people with DSD at the Usmanu Danfodiyo University Teaching Hospital in Sokoto, Nigeria. The data were collected using face-to-face interviews, transcribed verbatim, and analyzed using NVivo software.
RESULTS: The findings show that the participants experienced menstrual problems: men with menstruation and women with amenorrhea. The female participants generally described amenorrhea as a disappointment and linked menstruation with womanhood. Amenorrhea evinced both emotional and psychological effects. However, some of the female participants considered amenorrhea in a positive light and were happy with their lives without menstruation. The menstrual experiences of male participants included menarche, lower abdominal pain, regular monthly bleeding, and ovulation. The male participants described menstruation as a disaster in their lives and a source of anxiety, suicidal ideation, and depression. Menstruation negatively affected their psychosocial well-being.
CONCLUSIONS: The menstrual experience of individuals with DSD negatively affects their quality of life. The women with DSD in this study showed a generally poor knowledge of menarche, menstruation, and puberty, indicating that their parents had ignored the initial symptoms of DSD. DSD were only recognized at puberty because of the development of ambiguous physical traits and of the onset of menstruation in men and the confirmation of amenorrhea in women.

Matched MeSH terms: Amenorrhea/etiology*; Amenorrhea/epidemiology; Amenorrhea/psychology
Cervical ectopic pregnancy: a management dilemma

Shafiee, M.N., Norliza, I., Lim, P.S., Shuhaila, A., Mohd Hashim, O.

Journal of Surgical Academia, 2012;2(1):30-33.
MyJurnal

A 28-year-old G3P1+1 at 6 weeks period of amenorrhea with a previous Caesarean section presented with per vaginal bleeding. A cervical ectopic pregnancy was confirmed by a transvaginal scan. An intramuscular methotrexate was given followed by intracervical route due to poor decline of the serum βHCG. However, due to persistent increment of serum βHCG, an additional four doses of intramuscular methotrexate with folinic acid rescue were administered and she responded well to the regime. Unfortunately, following the last dose, she developed an episode of excessive per vaginal bleeding which required suction and curettage of the cervical canal. A Foley‘s catheter balloon was placed intracervically as a tamponade and the bleeding was successfully arrested.

Matched MeSH terms: Amenorrhea
Fulltext Bromocriptine-induced pregnancies in the amenorrhoea-galactorrhoea syndrome

Mustaffa BE, Khalid BAK, Satgunasingam N, Adeeb N, Tan PL, Chandran S

Med J Malaysia, 1983 Sep;38(3):237-43.
PMID: 6672568

13 patients with the amenorrhoea-galactorrhoea syndrome who conceived during treatment with bromocriptine were reported. Mean period of amenorrhoea was 3.0 years. In ten patients galactorrhoea was noted for a mean period of 4.2 years while in three it was discovered during examination. Seven patients presented with primary infertility. Menses returned in all cases after a mean duration of 2 months of treatment with bromocriptine at an average dose of 5. 86 mg daily. Mean serum prolactin was 4344 mUll (range 750 mU/l to 23,000 mU/l) before treatment and this declined to 186 mU/l with treatment. Seven patients became pregnant 5 to 25 months of treatment while six conceived after first menses. 21 pregnancies resulted from the thirteen patients. There was one spontaneous abortion and one premature delivery in which the baby died. Of the 16 live- births, there were twelve girls and four boys and their mean birth-weight was 2932 g. All were normal at birth and during subsequent developments except one with congenital dislocation of hip. It is concluded that bromocriptine is effective in restoring menstrual cycles and fertility by lowering serum prolactin in patients with the amenorrhoea-galactorrhoea syndrome. Bromocriptine may be safe for use during pregnancy, but it is suggested that the medication should be stopped immediately after conception unless tumour growth is apparent.

Matched MeSH terms: Amenorrhea/drug therapy*
Caudal regression syndrome associated with obstructive genital tract anomaly

Harun MHH, Mohd Nor NF, Ramli R

BMJ Case Rep, 2024 Jul 30;17(7).
PMID: 39079904 DOI: 10.1136/bcr-2024-261142

Transverse vaginal septum (TVS) is a rare obstructive genital tract anomaly. It is associated with primary amenorrhoea and typically presents with cyclical abdominal pain due to obstruction of the menstrual flow. Caudal regression syndrome (CRS) is also a rare congenital anomaly that is frequently associated with anomalies of the neurological, musculoskeletal, cardiac, genitourinary and gastrointestinal systems. Obstructive genital tract anomaly in CRS is exceptionally rare. This report describes the case of a girl in early adolescence with underlying CRS who presented with severe abdominal pain associated with primary amenorrhoea. Clinical and radiological assessment revealed 'haematocolpos' manifesting as a tender 20 weeks' size abdominal mass and an absent vaginal opening. TVS was identified during examination under anaesthesia. The patient subsequently underwent a successful vaginoplasty with no recurrence of symptoms after 2 years.

Matched MeSH terms: Amenorrhea/etiology
Fulltext The female athlete triad among elite Malaysian athletes: prevalence and associated factors

Quah YV, Poh BK, Ng LO, Noor MI

Asia Pac J Clin Nutr, 2009;18(2):200-8.
PMID: 19713179

Women participating in a wide range of competitive sports are at higher risk of developing eating disorders, menstrual irregularities and osteoporosis, which are generally referred to as the 'female athlete triad'. The objective of this study was to determine the prevalence of female athlete triad and factors associated with this condition among athletes participating in different sports. A total of 67 elite female athletes aged between 13-30 years participated in the study and were subdivided into the 'leanness' and 'non-leanness' groups. Eating disorders were assessed using a body image figure rating and the Eating Disorder Inventory (EDI) with body dissatisfaction (BD), drive for thinness (DT), bulimia (B) and perfectionism (P) subscales. Menstrual irregularity was assessed with a self-reported menstrual history questionnaire. Bone quality was measured using a quantitative ultrasound device at one-third distal radius. Prevalence of the female athlete triad was low (1.9%), but the prevalence for individual triad component was high, especially in the leanness group. The prevalence of subjects who were at risk of menstrual irregularity, poor bone quality and eating disorders were 47.6%, 13.3% and 89.2%, respectively, in the leanness group; and 14.3%, 8.3% and 89.2%, respectively, in the non-leanness group. Since the components of the triad are interrelated, identification of athletes at risk of having any one component of the triad, especially those participating in sports that emphasise a lean physique, is an important aid for further diagnosis.

Matched MeSH terms: Amenorrhea/epidemiology
The quality of life of adolescents with menstrual problems

Nur Azurah AG, Sanci L, Moore E, Grover S

J Pediatr Adolesc Gynecol, 2013 Apr;26(2):102-8.
PMID: 23337310 DOI: 10.1016/j.jpag.2012.11.004

To date, very few publications have examined the health related quality of life (HRQL) in the younger population with menstrual problems, despite their high prevalence in adolescent girls. We describe the health-related quality of life (HRQL) among adolescents with menstrual problems and identified factors that have an impact on it.

Matched MeSH terms: Amenorrhea/physiopathology; Amenorrhea/psychology
Ovarian failure in oral cyclophosphamide treatment for systemic lupus erythematosus

Wang CL, Wang F, Bosco JJ

Lupus, 1995 Feb;4(1):11-4.
PMID: 7767332 DOI: 10.1177/096120339500400103

Ninety-two women with systemic lupus erythematosus treated with oral cyclophosphamide were studied to ascertain the prevalence and the factors associated with ovarian dysfunction. Menstrual disturbance during treatment occurred in 55% of patients: 36% had amenorrhoea and 19% had oligomenorrhoea. Sustained oligomenorrhoea occurred in 12% patients. Permanent amenorrhoea (> 12 months) after cessation of oral cyclophosphamide occurred in 27% of patients. Hormonal studies in these patients were consistent with ovarian failure. Older age at initiation of treatment and high cumulative dose of cyclophosphamide were found to be associated with this outcome. There was a trend towards linear relationship between the age of initiation of cyclophosphamide therapy and frequency of amenorrhoea. A statistically significant association between amenorrhoea and cumulative dose of cyclophosphamide after adjustment for age was found whereas no such association was linked to the duration of treatment. Fourteen of the 23 women who wished to become pregnant after cessation of treatment conceived resulting in 20 live births and two abortions.

Matched MeSH terms: Amenorrhea/chemically induced*; Amenorrhea/epidemiology
The ameliorative effects of Eurycoma longifolia Jack on testosterone-induced reproductive disorders in female rats

Abdulghani M, Hussin AH, Sulaiman SA, Chan KL

Reprod Biol, 2012 Jul;12(2):247-55.
PMID: 22850474 DOI: 10.1016/s1642-431x(12)60089-8

The objective of this research was to study the ameliorative effects of a standardized quassinoid-rich extract (TAF 273) of Eurycoma longifolia root on some reproductive disorders in female rats. An irregular estrous cycle and ovarian cystic follicles were induced in 21-day-old females by the daily administration of testosterone (10 mg/kg, sc) for three weeks. The hormone-treated rats exhibited persistent diestrous as well as ovaries containing cystic follicles. Upon treatment with TAF 273, fewer animals showed irregular estrous cycles and there was less follicular morphological damage. The reversal effect may be derived from the anti-estrogenic properties of the plant quassinoids.

Matched MeSH terms: Amenorrhea/chemically induced; Amenorrhea/drug therapy*
Diagnostic pitfalls in the evaluation and management of amenorrhea in adolescents

Azurah AG, Zainuddin AA, Jayasinghe Y

J Reprod Med, 2013 Jul-Aug;58(7-8):324-36.
PMID: 23947083

Amenorrhea is a common menstrual problem seen in adolescents. Amenorrhea has been shown to have a negative impact on adolescents' quality of life. In this paper we discuss the various causes and investigations of amenorrhea in adolescents and address management dilemmas for specific conditions. Specific approaches in dealing with adolescents using the HEADSS (Home, Education, Activity, Drugs, Sexual activity, Suicidal) approach are discussed.

Matched MeSH terms: Amenorrhea/diagnosis*; Amenorrhea/etiology; Amenorrhea/therapy*
Cytogenetic profile of patients with clinical spectrum of ambiguous genitalia, amenorrhea, and Turner phenotype: A 21-year single-center experience

Elkarhat Z, Belkady B, Charoute H, Zarouf L, Razoki L, Aboulfaraj J, et al.

Am J Med Genet A, 2019 08;179(8):1516-1524.
PMID: 31207162 DOI: 10.1002/ajmg.a.61257

The aim of the present study was to determine the frequency and nature of chromosomal abnormalities involved in patients with the clinical spectrum of ambiguous genitalia (AG), amenorrhea, and Turner phenotype, in order to compare them with those reported elsewhere. The study was conducted in the Cytogenetic Department of Pasteur Institute of Morocco, and it reports on the patients who were recruited between 1996 and 2016. Cytogenetic analysis was performed according to the standard method. Among 1,415 patients, chromosomal abnormalities were identified in 7.13% (48/673) of patients with AG, 17.39% (28/161) of patients with primary amenorrhea (PA), 4% (1/25) of patients with secondary amenorrhea, and 23.20% (129/556) of patients with Turner phenotype. However, Turner syndrome was diagnosed in 0.89% (6/673) of patients with AG, 10.56% (17/161) of patients with PA, and 19.78% (110/556) of patients with Turner phenotype. In addition, Klinefelter syndrome and mixed gonadal dysgenesis were confirmed in 2.97% and 1.93% of patients, respectively, with AG, while, chimerism, trisomy 8, and trisomy 13 were confirmed only in 0.15% each. Trisomy 21 was confirmed in patients with AG and Turner phenotype (0.15% and 0.36%, respectively). Moreover, 5.60% (9/161) of patients with PA have been diagnosed as having sex reversal. Thus, the frequency of chromosomal abnormalities observed in Moroccan patients with PA is comparable to that reported in Tunisia, Turkey, Iran, and Hong Kong. However, the frequency is significantly less than that identified in India, Malaysia, Italy, and Romania.

Matched MeSH terms: Amenorrhea/genetics*; Amenorrhea/epidemiology; Amenorrhea/pathology
Fulltext Galactorrhoea in a toddler: a rare report

Norhayaty Sharman Khamis @ Roslee, Mohd Shaiful Ehsan Shalihin, Iskandar Ibrahim, Zalini Zin

Borneo Journal of Medical Sciences, 2020;14(2):49-52.
MyJurnal

Milk discharge from neonatal breast commonly occurs bilaterally. Majority of them are benign in nature. Those cases usually require conservative management and will resolve with time. It typically occurs within one month of age in which late-onset of galactorrhoea in toddlers is indeed a rare occasion. Thus, an abnormal cause needs to be ruled out. An 18-months-old child had persistent milky discharge from the left nipple for several days without underlying specific identified causes. This case highlights the occurrence of physiological milk discharge can still possibly occur at the age beyond one-year-old despite its absence in the initial months of life. The principle observation at primary care is still adequate in managing such cases unless high suspicion of alarming disease arises. This case proved a late onset of physiological galactorrhoea can still occur in the early toddler age group.

Matched MeSH terms: Amenorrhea
Fulltext The challenge in diagnosing and managing heterotopic interstitial pregnancy in natural conception

Noor Azura Noor Mohamad, Suzanna Daud, Sun Ta Thow, Darminder Singh Chopra, Bahiyah Abdullah

Journal of Clinical and Health Sciences, 2019;4(2):86-90.
MyJurnal

Heterotopic interstitial pregnancy in natural conception is very rare. Definitive diagnosis is
made by systematic pelvic ultrasound. Simultaneous viable conception observed in both intraand extra-uterine is pathognomonic of heterotopic interstitial pregnancy. We report a 34-yearold woman primigravida at 10 weeks’ amenorrhoea who underwent evacuation of retained
product of conception for missed miscarriage. Intraoperatively, minimal product of conception
was retrieved. Bedside pelvic ultrasound showed cystic mass at right superolateral part of
uterine fundus suspicious of interstitial pregnancy. Cornual resection was performed via
laparotomy. Histopathological examination showed presence of product of conception and
interstitial pregnancy. Serum β-human chorionic gonadotropin dropped from 10,027 IU/l on day
one post-ERPC to 210 IU/l at day three post-cornual resection. This case report highlighted
the challenge in diagnosing heterotopic interstitial pregnancy conceived naturally. Timely
diagnosis may avert dire consequences of massive haemorrhage from ruptured uterine cornua

Matched MeSH terms: Amenorrhea
Fulltext Swyer syndrome in a woman with pure 46, XY gonadal dysgenesis and a hypoplastic uterus

Azidah A, Nik Hazlina N, Aishah M

Malays Fam Physician, 2013;8(2):58-61.
PMID: 25606286 MyJurnal

Swyer syndrome or pure 46, XY gonadal dysgenesis is a condition in which the individuals have female appearance. They classically present as sexually infantile phenotypic females with primary amenorrhoea. People with this disorder have female external genitalia but the uterus and fallopian tubes are underdeveloped. However, they do not have functional gonads (ovaries or testes). Instead, they have streak gonads. We are reporting a case of Swyer syndrome with partially developed breasts, hypoplastic uterus, and absent streak gonads. The patient was treated with hormonal therapy and few years after her presentation, breast and uterine development were noted. In view that the patient is already married, the option of fertility was discussed with her. This case illustrates a rare case of gonadal dysgenesis and demonstrates the importance of counseling on the options of treatment, especially regarding fertility.

Matched MeSH terms: Amenorrhea
Fulltext Galactorrhoea in a male schizophrenic patient: a case report

Muhammad Chanchal Azad, Raihana Musawwir

Borneo Journal of Medical Sciences, 2015;9(1):0-0.
MyJurnal

Galactorrhoea is non-lactational milk production and it may or may not be associated with prolactinemia1. It causes embarrassment and distress to a schizophrenic patient, especially, if the patient is male. One study in Germany reported that incidence and prevalence of galactorrhoea in schizophrenia are 14% and 19%, respectively2. Although galactorrhoea is not rare in schizophrenic patients, managing and understanding the a etiology can be problematic. In psychiatric patients, antipsychotics can be a cause but other causes need to be ruled out. Galactorrhoea also needs to be differentiated from pathologic nipple discharge which can be due to breast tumours. Usually, galactorrhoea is bilateral, multiductal, and milky, but discharge can be yellow, green or brown3. This case report describes a 32-year old patient with schizophrenia who visited a government psychiatric hospital in Kota Kinabalu, Sabah, Malaysia. This report highlights the clinical challenges to determine the aetiology of galactorrhoea and to manage it in schizophrenics. It raises the following clinical questions: Why a psychiatric patient develops galactorrhoea? How a schizophrenic patient presents with galactorrhoea? What hormonal imbalances are associated with this psychiatric disorder? How should a doctor handle a schizophrenic patient complaining of galactorrhoea? What is the danger of having galactorrhoea in a male?

Matched MeSH terms: Amenorrhea
Incidence of chemotherapy-induced ovarian failure in premenopausal women undergoing chemotherapy for breast cancer

Tiong V, Rozita AM, Taib NA, Yip CH, Ng CH

World J Surg, 2014 Sep;38(9):2288-96.
PMID: 24700093 DOI: 10.1007/s00268-014-2542-y

Breast cancer is increasingly reported in young premenopausal women in Asia. Adjuvant chemotherapy improves survival; however, it has a unique consequence of ovarian failure in premenopausal patients.

Matched MeSH terms: Amenorrhea/blood; Amenorrhea/chemically induced*

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