Trastornos Menstruales de la Adolescente

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Abstract

Los trastornos menstruales constituyen una entidad clínica que se presenta frecuentemente durante los años de la adolescencia. En los primeros cinco años después de la menarquia, los ciclos menstruales anovulatorios asociados a la inmadurez del eje hipotálamo -hipófisis- ovario, son la causa más común de dichos trastornos. Otras condiciones patológicas tales como anomalías del tracto de salida, alteraciones gonadales, alteraciones del área hipotálamo-hipófisis, factores relacionados al estilo de vida, infecciones y otras enfermedades sistémicas pueden asociarse también a estos trastornos menstruales por lo que deben ser considerados como posibles diagnósticos diferenciales. El conocimiento de la fisiología del ciclo menstrual, así como todos los eventos asociados al periodo perimenarquia, son fundamentales para desarrollar protocolos de diagnóstico y tratamiento adecuado en las adolescentes.

Translated abstract

Menstrual abnormalities are a clinical problem that is encountered frequently during the adolescent years. In the first 5 years after menarche, anovulation that arises from a lack of maturity of the hypothalamic - pituitary - ovarian axis is the most common cause of such abnormalities. Other pathologic conditions, such as reproductive tract anomalies, primary ovarian failure, dysfunction of the hypothalamic - pituitary system, factors related to the life systems, infections and systemic illnesses could be also associated to menstrual disorders and thus it remains a diagnosis of exclusion. Knowledge of the menstrual cycle physiology, as well as the expected events that are associated with the perimenarchal period, is essential to develop careful diagnostic protocols and adolescent specific treatment regimens.

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Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome.

(2003)

Since the 1990 National Institutes of Health-sponsored conference on polycystic ovary syndrome (PCOS), it has become appreciated that the syndrome encompasses a broader spectrum of signs and symptoms of ovarian dysfunction than those defined by the original diagnostic criteria. The 2003 Rotterdam consensus workshop concluded that PCOS is a syndrome of ovarian dysfunction along with the cardinal features hyperandrogenism and polycystic ovary (PCO) morphology. PCOS remains a syndrome, and as such no single diagnostic criterion (such as hyperandrogenism or PCO) is sufficient for clinical diagnosis. Its clinical manifestations may include menstrual irregularities, signs of androgen excess, and obesity. Insulin resistance and elevated serum LH levels are also common features in PCOS. PCOS is associated with an increased risk of type 2 diabetes and cardiovascular events.

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Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome

EA-SPCWG Rotterdam, TR ESHRE, ESHRE/ASRM-Sponsored Rotterdam … (2004)

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Menstrual cyclicity after metformin therapy in polycystic ovary syndrome.

S Mendoza, Pablo Acosta, E. Sánchez-Velázquez (1997)

To assess the effect of insulin-lowering treatment on menstrual cyclicity in polycystic ovary syndrome (PCOS). Forty oligoamenorrheic women with PCOS were recruited in a prospective clinical study to receive metformin for a minimum period of 6 months. Twenty-two women completed the study. Serum LH, FSH, free testosterone, and glucose and insulin response to oral glucose load were measured both before and after 8 weeks of metformin treatment. Menstrual cyclicity and serum progesterone levels at the midluteal phase were assessed at the 30th week of metformin treatment. Twenty-one of 22 women had restoration of menstrual cyclicity (95.7%). Four of these women (19%) became pregnant within the 6th and 7th months of treatment. All four of the pregnant women delivered, and the infants were healthy. Thirteen of 15 women who had regular menses demonstrated a serum progesterone level within the ovulatory range (3.1-28 ng/mL). Fasting (P < .001) and the integrated insulin response to the glucose load decreased (P < .001) after 8 weeks of metformin treatment. This was accompanied by significant decreases in serum LH (P < .001) and free testosterone (P < .001) levels and LH/FSH ratio (P < .001). There was a small but significant reduction in body mass index after 8 weeks of metformin treatment (P < .001). A 6-month course of metformin may improve menstrual cyclicity and fertility in women with the PCOS. Insulin-sensitizing agents provide a rational approach to the treatment of the metabolic and endocrine abnormalities in PCOS women.