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Re: amenorrhea From: George M. Grunert, M.D. (grunert@ivfhouston.com) Sun Mar 5 09:19:09 2000 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: RModugno@aol.com: "Soy and hot flashes (Long)" Previous message: RModugno@aol.com: "Re: Successor to tongue studs: Trepanation" In reply to: Epippin@aol.com: "amenorrhea" Next in thread: Paul Prior MD: "Re: amenorrhea" Reply: Paul Prior MD: "Re: amenorrhea" If they're on BCPs or DepoProvera, they're adequately protected from osteoporosis. Those on meds which induce amenorrhea (such as phenothiazines which can result in hyperprolactinemia) and are not on hormones should be evaluated for estrogen status - a serum estradiol level, response to a progestin challenge test, or evidence of estrogen effect such as vaginal cytology. If they're hypoestrogenic, I'd treat them just as you would any other menopausal patient. -- George M. Grunert, M.D. Director, Assisted Reproductive Technology Program Obstetrical and Gynecological Associates 7550 Fannin Houston, TX 77054 713-512-7851 fax 713-512-7853 grunert@ivfhouston.com -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Epippin@aol.com Sent: Wednesday, March 01, 2000 6:46 PM To: Multiple recipients of list OB-GYN-L Subject: amenorrhea I am following a group of women who are institutionalized for mental health reasons and are on lots of psychotropic and seizure meds. These women are 20 years and older and most smoke. Some are sexually active. Many have been amenorrheic for years because of the meds they are on. Any interventions or testing I consider need to be kept to a minimum because of non-compliance. Those that are sexually active are on depo or BCP's unless >35 yo and smokers. My questions are 1) should I be concerned if they are amenorheic? osteoporosis? any other concerns? 2) how long is too long to be amenorrheic? should I try to induce a withdrawal bleed? if so, How often? 3) any particular workup recommended? TSH, Prolactin level? Dexa? Cell maturation index? pelvic ultrasound for endometrial stripe thickness? what recommendations would give the "biggest bang for the buck"? 4) are there treatment options I should be considering? Thanks for your input in advance. Ellen Kawadler MS, RN, CS, FNP Next message: RModugno@aol.com: "Soy and hot flashes (Long)" Previous message: RModugno@aol.com: "Re: Successor to tongue studs: Trepanation" In reply to: Epippin@aol.com: "amenorrhea" Next in thread: Paul Prior MD: "Re: amenorrhea" Reply: Paul Prior MD: "Re: amenorrhea"

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