Chapter 164 Anovulation
ETIOLOGY AND PATHOGENESIS
Causes: Physiologic—menopause (normal or premature), pregnancy; hormonal—elevated prolactin, hypothyroidism; functional—exercise (excessive), malnutrition, obesity, weight loss; drug-induced—alkylating chemotherapy, hormonal contraception, marijuana, tranquilizers; neoplasia—craniopharyngioma, hypothalamic hamartoma, pituitary adenoma (prolactin-secreting), small cell carcinoma of lung; psychogenic—anorexia nervosa, anxiety, pseudocyesis, stress; other—adrenal androgenization, central nervous system trauma, chronic medical illness, hemochromatosis, histiocytosis X, internal carotid artery aneurysms, irradiation, juvenile diabetes mellitus, polycystic ovary syndrome, Sheehan’s syndrome (postpartum ischemic necrosis), syphilitic gummas, tuberculosis, uremia.
DIAGNOSTIC APPROACH
Workup and Evaluation
Laboratory: Follicle-stimulating hormone (FSH), prolactin, thyroid function studies (e.g., sensitive thyroidstimulating hormone [TSH]), others as indicated clinically.
Special Tests: Basal body temperature charting may be used to detect ovulation, but other laboratory tests are more specific for establishing the cause.
