Anovulation Follow-up

  • Author: Armando E Hernandez-Rey, MD; Chief Editor: Richard Scott Lucidi, MD   more...
 
Updated: Oct 25, 2011
 

Further Inpatient Care

  • Inpatient care is directly related to the cause of anovulation.
  • Because of the menstrual irregularities associated with anovulation, anemia is a concern and must be treated with allogeneic blood transfusion if blood parameters fall below critical levels. Intravenous estrogen (Premarin) or high-dose combined oral contraceptives may be needed to ameliorate or terminate the acute bleeding episode. Dilation and curettage should never be the first-line treatment in this clinical setting; however, in the case of intractable bleeding, it may be the only alternative. Subtotal or total hysterectomy is rarely, if ever, necessary.
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Further Outpatient Care

Long-term health consequences, depending on their etiologic origin, include an increased risk for obesity, diabetes mellitus, heart disease, dyslipidemia, hypertension, endometrial hyperplasia, and infertility, and treatment must be focused on addressing these health concerns in addition to the primary causes (ie, PCOS). Therefore, aggressive preventative health care interventions are warranted, including interventions that lower cardiovascular risk factors through diet, exercise, and judicious use of statin medications when appropriate, as well as endometrial biopsy in the setting of chronic irregular bleeding regardless of age for the diagnosis of endometrial hyperplasia. Assessment must be continued at routine intervals (eg, every 4-6 mo).

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Complications

  • Endometrial hyperplasia
  • Insulin resistance or type 2 diabetes mellitus
  • Cardiovascular disease
  • Venous thromboembolism secondary to estrogen therapy
  • Electrolyte derangements (anorexia nervosa)
  • Arrhythmias (anorexia nervosa)

Pregnancy complications

Women with PCOS who conceive are at increased risk for gestational diabetes, preeclampsia, cesarean delivery, and preterm and post-term delivery. Their newborns are at increased risk of being large for gestational age but are not at increased risk of stillbirth or neonatal death.[34]

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Prognosis

Prognosis is generally favorable with appropriate and timely treatment.

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Patient Education

  • Education for these patients should focus on an understanding of the underlying disorders to ensure compliance with both medical therapy and lifestyle modifications.
  • For excellent patient education resources, visit eMedicine's Eating Disorders Center and Women's Health Center. Also, see eMedicine's patient education article, Anorexia Nervosa.
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Contributor Information and Disclosures
Author

Armando E Hernandez-Rey, MD  Consulting Staff, Fertility and IVF Center of Miami

Armando E Hernandez-Rey, MD is a member of the following medical societies: American Association of Gynecologic Laparoscopists, American College of Obstetricians and Gynecologists, American Medical Association, American Society for Reproductive Medicine, Society for Gynecologic Investigation, Society for Reproductive Endocrinology and Infertility, and Society of Laparoendoscopic Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Carl V Smith, MD  The Distinguished Chris J and Marie A Olson Chair of Obstetrics and Gynecology, Professor, Department of Obstetrics and Gynecology, Senior Associate Dean for Clinical Affairs, University of Nebraska Medical Center

Carl V Smith, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, Association of Professors of Gynecology and Obstetrics, Central Association of Obstetricians and Gynecologists, Council of University Chairs of Obstetrics and Gynecology, Nebraska Medical Association, and Society for Maternal-Fetal Medicine

Disclosure: Nothing to disclose.

Frederick B Gaupp, MD  Consulting Staff, Department of Family Practice, Hancock Medical Center

Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians

Disclosure: Nothing to disclose.

Chief Editor

Richard Scott Lucidi, MD  Associate Professor of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Virginia Commonwealth University School of Medicine

Richard Scott Lucidi, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists and American Society for Reproductive Medicine

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Krystene I Boyle, MD, Cassandra Blot, MD, and Peter G McGovern, MD, to the development and writing of this article.

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Anovulation. Polycystic ovary. Courtesy of Jairo E. Garcia, MD.
Anovulation. On the left is an unaffected patient aged 12 years. On the right is the same patient aged 13 years after developing Cushing disease.
Anovulation. Left adrenal mass discovered incidentally.
Anovulation. MRI showing a nonenhancing area in the pituitary consistent with a microadenoma in a patient with hyperprolactinemia.
 
 
 
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