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The regulation of the menstrual cycle in women is an intricate interplay between the hypothalamic, pituitary and gonadal hormones. Immediately following menarche most menstrual cycles are anovulatory and hence the interval between menstruations is slightly irregular. After 2–4 years most girls will have regular periods. However, a small number will continue to have irregular or even absent menses. Other women will develop irregular cycles later on in life as they gain weight. In others the disappearance of menses might be associated with other disturbing symptoms. Anovulatory cycles are classified as having central, peripheral or combined causes. Apart from subfertility, anovulation is also associated with other short-term as well as long-term health issues such as hirsutism, obesity, metabolic syndrome, cardiovascular disease, osteoporosis and type 2 diabetes mellitus. Therefore, women with irregular menstrual cycles deserve proper medical attention, appropriate care and sufficient follow-up during their whole lifespan in order to prevent and timely treat some of the disturbing symptoms and health sequelae later on in life.
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Not having regular ovulations
Interval between menses exceeding 35
Interval being shorter than 21 days
No menses at all or interval exceeding 199 days
First menstrual period ever
Last menstrual period
Absent ovarian activity due to lack of central stimulation
Normogonadotropic normo-oestrogenic anovulation
Combined central and peripheral cause of anovulation
Polycystic ovary syndrome
Irresponsive ovary due to absence of follicles
Primary ovarian insufficiency
Anosmic hypogonadotropic hypogonadism
Male type of scalp hair loss in women
Low bone mineral density, T score between −1.0 and −2.5.
Decreased (too low) bone mineral density T score lower than −2.6
Loss of the sense of smell
Laparoscopic ovarian diathermy (LOD) (drilling)
Destruction of ovarian tissue using electro-cauterization
Hormone replacement therapy (HRT)
Replacement of oestrogens and progestogens in order to replace the missing sex steroids
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- The normal and abnormal menstrual cycle
Joop S. E. Laven
Nils B. Lambalk
- Bohn Stafleu van Loghum