yroid Dysfunction yroid Dysfunction Both hyperthyroidism and hypothyroidism may result in menstrual qisturbances secondary
to anovulation. The mechanism for menstrual dysfunction appears to be alterations in
the
metabolism and interconversion of androgens and estrogens. The deg
ee of disturbance
varies 
rom Man enorrheao dysfunctional uterine bleeding. Except for severe cases, most
hyperthyroid patients remain ovulatory and fertile. Therefore, pregnancy should be
considered in the amenorrheic hyperthyroid patient.9
In hypothyroidism, the result of the hormonal alterations is an increase in estrogens
which may lead to in
appropriate gonadotropin
secretion and anovulation. In hypothyroidism,
the serum PRL level ma
y also be increased and galactorrhea may occur.9 This may
be due to the fact that thyrotropin releasing hormone (TRH) may increase the secretion of
both thyroid stimulating hormone (TSH) and PRL. An alternative explanation is that there
is diminished hypothalamic dopamine turnover.9 These disturbances (i.e.
hyperprolactinemia and galactorrhea) will resolve with thyroxine treatment.10
Prolactin (PRL) is secreted primarily by the pituitary lactotrophs from the posterolateral aspects of the adenohypophysis, the most common location of prolactinomas. Prolactin is a peptide hormone and is structurally similar to somatomammotropic hormones, including growth hormone and human placental lactogen. Prolactin release is stimulated by a variety of substances, such as TRH, GnRH and oxytocin. The anovulatory mechanism in hyperprolactin-emic amenorrhea is thought to be inhibition of GnRH pulsatility by elevated PRL levels.11 Hyperprolactinemia leads to a failure of the positive feedback response of gonadotropin secretion induced by estrogen.12 Therefore, patients exhibit low levels of LH and FSH.
Most laboratories report an upper range of normal of 20 to 30 ng/mI for prolactin levels. A single elevated prolactin level should be repeated as prolactin is a dynamic hormone. Patients with prolactin levels greater than 100 ng/ml should undergo pituitary imaging (magnetic resonance imaging or computed tomography). A TSH level should be obtained to rule out hypothyroidism. Imaging could be obtained at lower levels as it was found that levels greater than 50 ng/ml were associated with a 20% frequency; 100 ng/ml, a 50% frequency; and greater than 100 ng/ml, a nearly 100% frequency of a pituitary tumor.13
Prolactinomas are categorized as microadenomas (< 1 cm) or macroadenomas (> 1 cm). Microadenomas can be managed expectantly. Symptomatic patients and patients with macroadenomas can be treated medically or surgically. The majority of patients respond to medical treatment. Most infertile patients with elevated prolactin require therapy.
In industrialized countries, the annual incidence of pelvic inflammatory disease (PID) in women aged 15 to 39 appears to be 10 to 13 per 1,000 women, with a peak incidence of approximately 20 per 1,000 women in the age group 20 to 24 years.14 The incidence of PID is correlated strongly with the prevalence of sexually transmitted diseases (STD's), namely Neisseria gonorrhea and Chlamydia trachomatis. The risk of acquiring an STD increases with the number of sexual partners of either the male or the female. In addition, associated risk factors include early age at first coitus, single marital status and history of illicit drug use. Westrom's investigations have shown that women who have had acute PID are at significantly increased risk to develop tubal factor infertility or ectopic pregnancy (6- to 10-fold increased risk of ectopic).14 pInfertility: Etiology And Evaluation e Lesbian Men d d Dating Online aInfertility: Etiology And Evaluation b r Lesbian Dating Online Dating