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April 23, 1997, Vol 277, No. 16 >
ARTICLE | April 23, 1997

A 21-Year-Old Woman With Menstrual Irregularity FREE

Ann Davis, MD
[+] Author Affiliations

This conference took place at the Obstetrics/Gynecology Grand Rounds of the Beth Israel Deaconess Medical Center, East Campus, Boston, Mass, on December 11, 1996.

Reprints: Erin E. Hartman, MS, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, East Campus, 330 Brookline Ave, LY339, Boston, MA 02215.

Clinical Crossroads at Beth Israel Deaconess Medical Center is produced and edited by Thomas L. Delbanco, MD, and Jennifer Daley, MD; Erin E. Hartman, MS, is managing editor. Clinical Crossroads section editor: Margaret A. Winker, MD, Senior Editor, JAMA.


JAMA. 1997;277(16):1308-1314. doi:10.1001/jama.1997.03540400058032
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References

Dr Daley:  Ms K is a 21-year-old single college student who has had difficulty with her menses for a year. She moved to this country in late 1995 to attend college. She studies education and lives with a friend in Boston. She has commercial indemnity insurance.Ms K experienced menarche at the age of 12 years and had regular periods every month lasting about 4 days. Mild cramps accompanied her menses, and she had bloating and breast tenderness prior to them. She has never been on birth control pills and has never been pregnant. Before coming to Boston, she was sexually active, used condoms, and received 2 shots (she does not remember the medication) for birth control at 3-month intervals, with the most recent injection in April or May 1995. She menstruated normally in July through October, but then began bleeding continuously in November 1995. Bleeding varied from heavy to

REFERENCES

1 +
Treolar AE, Boynton RE, Behn BG, Brown BW.  Variation of the human menstrual cycle through reproductive life . Int J Fertil . 1967;;12:77-126.
2 +
Harlow SD, Zeger SL.  Application of longitudinal methods to the analysis of menstrual diary data . J Clin Epidemiol . 1991;;44:1015-1025.
3 +
Bayer SR, DeCherney AH.  Clinical manifestations and treatment of dysfunctional uterine bleeding . JAMA . 1993;;269:1823-1828.
4 +
Hallberg L, Hogdahl AM, Nilsson L, Rybo G.  Menstrual blood loss—a population study: variation at different ages and attempts to define normality . Acta Obstet Gynecol Scand . 1966;;45:320-351.
5 +
Fraser IS, McCarron G, Markham R.  A preliminary study of factors influencing perception of menstrual blood loss volume . Am J Obstet Gynecol . 1984;;149:788-793.
6 +
Chimbira TH, Anderson AC, Turnbull AC.  Relation between measured menstrual blood loss and patients' subjective assessment of loss, duration of bleeding, number of sanitary towels used, uterine weight and endometrial surface area . Br J Obstet Gynaecol . 1980;;87:603-669.
7 +
Garza-Flores J, Cardenas S, Rodriguez V, Craviota MC, Diaz-Sanchez V, Perez-Palacios G.  Return to ovulation following the use of long-acting injectable contraceptives: a comparative study . Contraception . 1985;;31:361-366.
8 +
Schwallie PC, Assenzo JR.  The effect of acetate on pituitary and ovarian function, and the return of fertility following discontinuation: a review . Contraception . 1974;;10:181-202.
9 +
Speroff L, Glass R, Kase N. Clinical Gynecologic Endocrinology and Infertility . Baltimore, Md: Williams & Wilkins; 1994;.
10 +
Lobo RA.  A disorder without identity: 'HCA,' 'PCO,' 'PCOD,''SLS': what are we to call it?! Fertil Steril . 1995;;63:1158-1160.
11 +
Yen SSC.  The polycystic ovarian syndrome . Fertil Steril . 1992;;58:37-45.
12 +
Frisch RE, McArthur JW.  Menstrual cycles: fatness as a determinant of minimum weight for height for their maintenance or onset . Science . 1974;;185: 949-951.
13 +
Technical Bulletin: Dysfunctional Uterine Bleeding. Washington, DC: American College of Obstetricians and Gynecologists; 1989.
14 +
Harlap S, Kost K, Forrest JD. Preventing Pregnancy, Protecting Health . New York, NY: The Alan Institute; 1991;.
15 +
Krettek JE, Arkin SI, Chaisilwattana P, Monif G.  Chlamydia trachomatis in patients who used oral contraceptives and had intermenstrual spotting . Obstet Gynecol . 1993;;81:728-731.
16 +
Shangold M, Rebar R, Wentz AC, Schiff I.  Evaluation and management of menstrual dysfunction in athletes . JAMA . 1990;;263:1665-1669.
17 +
Constantini NW, Warren MP.  Menstrual dysfunction in swimmers: a distinct entity . J Clin Endocrinol Metab . 1995;;80:2740-2744.
18 +
Pirke KM, Schweiger U, Lemmel W, Krieg JC, Berger M.  The influence of dieting on the menstrual cycle of healthy young women . J Clin Endocrinol Metab . 1985;;60:1174-1179.
19 +
Pirke KM, Schweiger U, Laessle R, Dickhaut B, Schwieger M, Waechtler M.  Dieting influences the menstrual cycle: vegetarian versus nonvegetarian diet . Fertil Steril . 1986;;46:1083-1087.
20 +
Schweiger U, Laessle R, Pfister H, et al.  Diet-induced menstrual irregularities: effect of age and weight loss . Fertil Steril . 1987;;48:746-751.
21 +
Pirke KM, Schweiger U, Strowitzki T, et al.  Dieting causes menstrual irregularities in normal weight young women through impairment of episodic luteinizing hormone secretion . Fertil Steril . 1989;;51:263-268.
22 +
Pirke KM, Fichter MM, Chlond C, et al.  Disturbances of the menstrual cycle in bulimia nervosa . Clin Endocrinol . 1987;;27:245-254.
23 +
Schweiger U, Broocks A, Tuschl R, Laessle R, Platte P, Pirke KM.  Everyday eating behavior and menstrual function in young women . Fertil Steril . 1995;;57:771-775.
24 +
Schwartz B, Cumming DC, Riordan E, Selye M, Yen SSC, Rebar RW.  Exercise-associated amenorrhea: a distinct entity? Am J Obstet Gynecol . 1981;; 141:662-670.
25 +
Warren MP.  The effects of exercise on pubertal progression and reproductive function in girls . J Clin Endocrinol Metab . 1980;;51:1150-1157.
26 +
Sheldrake P, Cormach M.  Variation in menstrual cycle symptoms reporting . J Psychosom Res . 1976;;20:169-174.
27 +
Drew FL,Stifel EN.  Secondary amenorrhea among young women entering religious life . Obstet Gynecol . 1968;;32:47-51.
28 +
Suh BY, Lui JH, Berga SL, Quigley ME, Laughlin GA, Yen SS.  Hypercortisolism in patients with functional hypothalamic amenorrhea . J Clin Endocrinol Metab . 1988;;66:773-739.
29 +
Berga SL, Mortola JF, Girton B, et al.  Neuroendocrine aberrations in women with functional hypothalamic amenorrhea . J Clin Endocrinol Metab . 1989;;68:301-308.
30 +
Loucks AB, Mortola JF, Girton, Yen SSC.  Alterations in the hypothalamicpituitary-ovarian and hypothalamic-pituitary-adrenal axes in athletic women . J Clin Endocrinol Metab . 1989;;68:401-411.
31 +
Giles DE, Berga SL.  Cognitive and psychiatric correlates of functional hypothalamic amenorrhea: a controlled comparison . Fertil Steril . 1993;;60:486-492.
32 +
Hull MGR, Knuth UA, Murray MAF, Jacobs HS.  The practical value of the progestogen challenge test, serum oestradiol estimation or clinical examination in assessment of the oestrogen state and response to clomiphene in amenorrhea . Br J Obstet Gynaecol . 1979;;86:799-886.
33 +
Jones KP, Ravnikar VA, Tulchinsky D, Schiff I.  Comparison of bone density in amenorrheic women due to athletics, weight loss, and premature menopause . Obstet Gynecol . 1986;;66:55-57.
34 +
Schlechte J, Dolan K, Sherman B, Chapler F, Luciano A.  The natural history of untreated hyperprolactinemia: a prospective analysis . J Clin Endocrinol Metab . 1989;;68:412-418.
35 +
Sisam DA, Sheehan JP, Sheeler LR.  The natural history of untreated microprolactinomas . Fertil Steril . 1987;;48:67-71.
36 +
Schedlowski M, Wiechert D, Wagner TO, Tewes U.  Acute psychological stress increases plasma levels of cortisol, prolactin, and TSH . Life Sci . 1992;; 50:1201-1205.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Treolar AE, Boynton RE, Behn BG, Brown BW.  Variation of the human menstrual cycle through reproductive life . Int J Fertil . 1967;;12:77-126.
2 +
Harlow SD, Zeger SL.  Application of longitudinal methods to the analysis of menstrual diary data . J Clin Epidemiol . 1991;;44:1015-1025.
3 +
Bayer SR, DeCherney AH.  Clinical manifestations and treatment of dysfunctional uterine bleeding . JAMA . 1993;;269:1823-1828.
4 +
Hallberg L, Hogdahl AM, Nilsson L, Rybo G.  Menstrual blood loss—a population study: variation at different ages and attempts to define normality . Acta Obstet Gynecol Scand . 1966;;45:320-351.
5 +
Fraser IS, McCarron G, Markham R.  A preliminary study of factors influencing perception of menstrual blood loss volume . Am J Obstet Gynecol . 1984;;149:788-793.
6 +
Chimbira TH, Anderson AC, Turnbull AC.  Relation between measured menstrual blood loss and patients' subjective assessment of loss, duration of bleeding, number of sanitary towels used, uterine weight and endometrial surface area . Br J Obstet Gynaecol . 1980;;87:603-669.
7 +
Garza-Flores J, Cardenas S, Rodriguez V, Craviota MC, Diaz-Sanchez V, Perez-Palacios G.  Return to ovulation following the use of long-acting injectable contraceptives: a comparative study . Contraception . 1985;;31:361-366.
8 +
Schwallie PC, Assenzo JR.  The effect of acetate on pituitary and ovarian function, and the return of fertility following discontinuation: a review . Contraception . 1974;;10:181-202.
9 +
Speroff L, Glass R, Kase N. Clinical Gynecologic Endocrinology and Infertility . Baltimore, Md: Williams & Wilkins; 1994;.
10 +
Lobo RA.  A disorder without identity: 'HCA,' 'PCO,' 'PCOD,''SLS': what are we to call it?! Fertil Steril . 1995;;63:1158-1160.
11 +
Yen SSC.  The polycystic ovarian syndrome . Fertil Steril . 1992;;58:37-45.
12 +
Frisch RE, McArthur JW.  Menstrual cycles: fatness as a determinant of minimum weight for height for their maintenance or onset . Science . 1974;;185: 949-951.
13 +
Technical Bulletin: Dysfunctional Uterine Bleeding. Washington, DC: American College of Obstetricians and Gynecologists; 1989.
14 +
Harlap S, Kost K, Forrest JD. Preventing Pregnancy, Protecting Health . New York, NY: The Alan Institute; 1991;.
15 +
Krettek JE, Arkin SI, Chaisilwattana P, Monif G.  Chlamydia trachomatis in patients who used oral contraceptives and had intermenstrual spotting . Obstet Gynecol . 1993;;81:728-731.
16 +
Shangold M, Rebar R, Wentz AC, Schiff I.  Evaluation and management of menstrual dysfunction in athletes . JAMA . 1990;;263:1665-1669.
17 +
Constantini NW, Warren MP.  Menstrual dysfunction in swimmers: a distinct entity . J Clin Endocrinol Metab . 1995;;80:2740-2744.
18 +
Pirke KM, Schweiger U, Lemmel W, Krieg JC, Berger M.  The influence of dieting on the menstrual cycle of healthy young women . J Clin Endocrinol Metab . 1985;;60:1174-1179.
19 +
Pirke KM, Schweiger U, Laessle R, Dickhaut B, Schwieger M, Waechtler M.  Dieting influences the menstrual cycle: vegetarian versus nonvegetarian diet . Fertil Steril . 1986;;46:1083-1087.
20 +
Schweiger U, Laessle R, Pfister H, et al.  Diet-induced menstrual irregularities: effect of age and weight loss . Fertil Steril . 1987;;48:746-751.
21 +
Pirke KM, Schweiger U, Strowitzki T, et al.  Dieting causes menstrual irregularities in normal weight young women through impairment of episodic luteinizing hormone secretion . Fertil Steril . 1989;;51:263-268.
22 +
Pirke KM, Fichter MM, Chlond C, et al.  Disturbances of the menstrual cycle in bulimia nervosa . Clin Endocrinol . 1987;;27:245-254.
23 +
Schweiger U, Broocks A, Tuschl R, Laessle R, Platte P, Pirke KM.  Everyday eating behavior and menstrual function in young women . Fertil Steril . 1995;;57:771-775.
24 +
Schwartz B, Cumming DC, Riordan E, Selye M, Yen SSC, Rebar RW.  Exercise-associated amenorrhea: a distinct entity? Am J Obstet Gynecol . 1981;; 141:662-670.
25 +
Warren MP.  The effects of exercise on pubertal progression and reproductive function in girls . J Clin Endocrinol Metab . 1980;;51:1150-1157.
26 +
Sheldrake P, Cormach M.  Variation in menstrual cycle symptoms reporting . J Psychosom Res . 1976;;20:169-174.
27 +
Drew FL,Stifel EN.  Secondary amenorrhea among young women entering religious life . Obstet Gynecol . 1968;;32:47-51.
28 +
Suh BY, Lui JH, Berga SL, Quigley ME, Laughlin GA, Yen SS.  Hypercortisolism in patients with functional hypothalamic amenorrhea . J Clin Endocrinol Metab . 1988;;66:773-739.
29 +
Berga SL, Mortola JF, Girton B, et al.  Neuroendocrine aberrations in women with functional hypothalamic amenorrhea . J Clin Endocrinol Metab . 1989;;68:301-308.
30 +
Loucks AB, Mortola JF, Girton, Yen SSC.  Alterations in the hypothalamicpituitary-ovarian and hypothalamic-pituitary-adrenal axes in athletic women . J Clin Endocrinol Metab . 1989;;68:401-411.
31 +
Giles DE, Berga SL.  Cognitive and psychiatric correlates of functional hypothalamic amenorrhea: a controlled comparison . Fertil Steril . 1993;;60:486-492.
32 +
Hull MGR, Knuth UA, Murray MAF, Jacobs HS.  The practical value of the progestogen challenge test, serum oestradiol estimation or clinical examination in assessment of the oestrogen state and response to clomiphene in amenorrhea . Br J Obstet Gynaecol . 1979;;86:799-886.
33 +
Jones KP, Ravnikar VA, Tulchinsky D, Schiff I.  Comparison of bone density in amenorrheic women due to athletics, weight loss, and premature menopause . Obstet Gynecol . 1986;;66:55-57.
34 +
Schlechte J, Dolan K, Sherman B, Chapler F, Luciano A.  The natural history of untreated hyperprolactinemia: a prospective analysis . J Clin Endocrinol Metab . 1989;;68:412-418.
35 +
Sisam DA, Sheehan JP, Sheeler LR.  The natural history of untreated microprolactinomas . Fertil Steril . 1987;;48:67-71.
36 +
Schedlowski M, Wiechert D, Wagner TO, Tewes U.  Acute psychological stress increases plasma levels of cortisol, prolactin, and TSH . Life Sci . 1992;; 50:1201-1205.

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