eMedicine Specialties > Obstetrics and Gynecology > Reproductive Endocrinology and Infertility

Anovulation: Follow-up

Author: Armando E Hernandez-Rey, MD, Consulting Staff, Fertility and IVF Center of Miami
Coauthor(s): Krystene I Boyle, MD, Staff Physician, Department of Obstetrics and Gynecology, University Hospital of New Jersey Medical School; Cassandra Blot, MD, Staff Physician, Department of Obstetrics and Gynecology, Robert Wood Johnson University Hospital; Peter G McGovern, MD, Associate Professor and Director, Department of Obstetrics, Gynecology, and Women's Health, Division of Reproductive Endocrinology and Infertility, UMDNJ-New Jersey Medical School
Contributor Information and Disclosures

Updated: Jan 15, 2008

Follow-up

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.

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).

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)

Prognosis

  • Prognosis is generally favorable with appropriate and timely treatment.

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.

Miscellaneous

Medicolegal Pitfalls

  • Diagnosis and treatment of PCOS must begin in a timely fashion in order to help reduce the morbidity and mortality from diabetes mellitus and cardiovascular disease. There is a genetic component to PCOS, and it is usually seen in first- and second-degree relatives.
  • Patients with chronic anovulation are at increased risk for endometrial hyperplasia and malignancy, and endometrial sampling is imperative.
  • Food and Drug Administration (FDA) approval has not been obtained for any of the treatments usually used in the treatment of hirsutism. Patients must be aware of the risks involved in using these medications.
 


More on Anovulation

Overview: Anovulation
Differential Diagnoses & Workup: Anovulation
Treatment & Medication: Anovulation
Follow-up: Anovulation
Multimedia: Anovulation
References
Further Reading
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Further Reading

See Medscape's Ob/Gyn and Women's Health.

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Keywords

dysfunctional uterine bleeding, DUB, amenorrhea, chronic anovulation, hypogonadotropic hypogonadism, hypergonadotropic hypogonadism, luteinizing hormone, LH, gonadotropin-releasing hormone, GnRH, polycystic ovary syndrome, PCOS, follicle-stimulating hormone, FSH, hypothalamic-pituitary-ovarian axis, HPO axis

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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.

Coauthor(s)

Krystene I Boyle, MD, Staff Physician, Department of Obstetrics and Gynecology, University Hospital of New Jersey Medical School
Krystene I Boyle, MD is a member of the following medical societies: Sigma Xi
Disclosure: Nothing to disclose.

Cassandra Blot, MD, Staff Physician, Department of Obstetrics and Gynecology, Robert Wood Johnson University Hospital
Cassandra Blot, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists
Disclosure: Nothing to disclose.

Peter G McGovern, MD, Associate Professor and Director, Department of Obstetrics, Gynecology, and Women's Health, Division of Reproductive Endocrinology and Infertility, UMDNJ-New Jersey Medical School
Disclosure: Nothing to disclose.

Medical Editor

Gerard S Letterie, DO, Associate Clinical Professor, Medical Director of In-vitro Fertilization Lab, Department of Obstetrics and Gynecology, Virginia Mason Medical Center, University of Washington
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Carl V Smith, MD, The Distinguished Chris J and Marie A Olson Chair of Obstetrics and Gynecology, Professor, Department of Obstetrics and Gynecology, 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, American Medical Association, Arkansas Medical Society, 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.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Assumption Community Hospital
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

Bryan D Cowan, MD, Professor and Chairman, Department of Obstetrics and Gynecology, University of Mississippi College of Medicine; Consulting Staff, Department of Obstetrics and Gynecology, Veterans Affairs Medical Center; Medical Director, Wiser Hospital for Women, University of Mississippi Medical Center
Bryan D Cowan, MD is a member of the following medical societies: American Association of Gynecologic Laparoscopists, American College of Obstetricians and Gynecologists, American Gynecological and Obstetrical Society, American Medical Association, American Society for Reproductive Medicine, Association of Professors of Gynecology and Obstetrics, Central Association of Obstetricians and Gynecologists, Endocrine Society, Sigma Xi, Society for Assisted Reproductive Technologies, Society for Gynecologic Investigation, Society for the Study of Reproduction, and Society of Laparoendoscopic Surgeons
Disclosure: Nothing to disclose.

 
 
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