Female Reproductive Problems

General

Reproductive problems in women include absent or irregular periods, adult acne, increased undesirable facial and body hair or hirsutism, and scalp hair loss. The most frequent cause for these symptoms is polycystic ovary syndrome, PCOS, affecting up to 20% of women. These symptoms may also be caused by other hormonal disorders, and careful evaluation is necessary to determine the cause and select the best treatment..

SYMPTOMS

Menstrual disorders include absence of periods, or amenorrhea, which may be primary, with no periods ever seen, or secondary, with periods stopping after being seen initially after puberty. Periods may be irregular, occurring close together, or have gaps of many months or even years. There may be effects of excess androgens, or male hormones, which include oily skin and acne, increased undesirable facial and body hair, and male pattern scalp hair loss. Women who are athletes or ballet dancers, or who have eating disorders, may have an inadequate amount of body fat which can cause absent or infrequent periods. This may result in inadequate estrogen effects, which can cause bone loss, scalp hair loss, urinary urgency and frequency, and vaginal dryness and pain. PCOS is often a cause of increased weight and insulin resistance, which can lead to diabetes and increase risk of heart attack and stroke.

Diagnosis

The cause of a woman's symptoms can be determined by thorough history, careful examination, and appropriate lab tests. Symptoms most be reviewed, and clues revealed by the physical examination. Lab tests must look at pituitary, thyroid, adrenal and ovarian hormones, as well as tests to look for systemic illness which can affect reproductive function.

Treatment

Therapy is determined by the cause which is revealed, and whether the patient seeks fertility. For example, if a woman with PCOS does not want to get pregnant, but wants to reduce acne, hirsutism, and obesity, and make periods regular, she could be treated with birth control pills, anti-androgen medication, and medicines to reduce insulin resistance. If she wants to get pregnant, these medications would not be used. She would receive medication to induce ovulation. Other conditions would be treated with medications directed at the cause.