Gynecologic Endocrinology Ecab

Reproductive Endocrinology - ECAB - E-Book

The diagnostic approach as well as the management of several endocrinological disorders underwent major modifications. Gynecological endocrinology made no exception, and light was finally thrown on a scarcely known area, so heavily influenced by ignorance and prejudices. Here some authoritative experts have addressed the several possibilities of hormonal interventions in the field of gynecology. The most recent research development has led to the better understanding of the physiopathological rationale, underlying appropriate treatments and even evaluation of the new routes of hormone administration. Current medical therapy of different conditions has been thoroughly reviewed, including precocious puberty, hyperandrogenism, premature ovarian failure, polycystic ovarian syndrome, and menopause. Keeping in mind the requirements of the society, the practitioners need to update themselves on the current approach and wide variety of treatment options now available. India has a distinct need for the comprehensive programs that fit into the Indian context of the situation. It has to be a continuous process, which approaches the problem on the basis of the experience of the specialists in India who are among the stalwarts in this field. In its quest to better approach the topic, Elsevier has pooled its existing resources with those of the internationally acclaimed Obstetricians and Gynecologists of India who have chosen to apply their rich clinical knowledge and expertise to serve the Indian patients.

PCOS is a complex endocrinopathy with wide-ranging variations and clinical manifestations. In the field of gynecology, the clinician is called upon to treat problems of menstrual irregularity, acne and hirsutism, infertility, obesity, and for education on long-term consequences. The mainstay of pharmacological treatment aims at ovarian suppression of androgen secretion. The most effective medical therapy for hirsutism in these cases thus appears to be antiandrogen drugs. The patients need to undergo the therapies for long periods and also understand the need of maintenance. Electrolysis and laser photothermolysis are considered the most effective cosmetic procedures. PCOS is a heterogeneous disorder and no single etiological factor fully accounts for the whole spectrum of the abnormalities in this condition. Only a few genes and mutations show considerable evidence of association with PCOS. Variable manifestation observed within PCOS patients may be due to the interaction with environmental factors with protective genomic variant and predisposing genes. The eminent authors of "Polycystic Ovary Syndrome" have enumerated the various options available described in detail their experiences regarding the various aspects of the condition.

Even though it seems simple the ability of the mother’s body to retain and nurture the fetus, which is of a non-identical genetic makeup, throughout the gestational period requires a delicate balance of hormonal orchestration to achieve the required immunological permissiveness. The obvious outcome of a failure to achieve this is rejection of the fetal "semi-allograft", which manifests as threatened miscarriage. The occurrence of threatened miscarriage or symptoms suggestive of it is fraught with anxiety both for the patient and the obstetrician, especially if the baby is eagerly awaited. In such a situation, a correct diagnosis and prompt evaluation is imperative to start immediate interventions and prevent the expulsion of the fetus. However it is equally important to rule out the other conditions that may mimic threatened miscarriage and avoid unnecessary interventions. This clinical update handbook attempts to address these and other issues associated with this potentially elusive condition. The first chapter serves to give a concise yet relevant overview about this topic. The various modes of presentation as well as the management protocol are elaborately covered in the second chapter. The chapter on Diagnostic Modalities explains how the risk factors and investigative findings can be used to predict and make an early diagnosis of the condition. It has also touched upon the other conditions that mimic threatened miscarriage and how those can be differentiated from it. The role of stress and how it affects the immunomodulation which is the basis of maternal tolerance of the fetus, is explored in detail in the fourth chapter. The last chapter highlights the complications associated with inappropriate treatment of the condition and explores the adverse effects and relative safety of the recommended treatment protocol. Most of the chapters also include several case reviews that illustrate the aspects covered and are enriched with the vast repertoire of personal experience of the eminent authors.

It is an established fact that thyroid hormones play an important role in the metabolism of the body. Pregnancy is a state of significant hormonal as well as metabolic changes, and thyroid hormones have a significant impact on maternal metabolism and fetal development during pregnancy. The fetus relies on maternal thyroid hormone for the development of the CNS, especially in the early stages of gestation, and uncorrected maternal hypothyroidism in this period can leave the child with permanent life-long neurological deficits. From the maternal point of view, a thyroid dysfunction encountered during pregnancy may continue even after delivery as postpartum thyroiditis. Hence, any thyroid dysfunction, be it hypo- or hyperthyroidism, can have serious deleterious consequences if not detected promptly and managed properly. The established guidelines and newer trends for the treatment of thyroid dysfunction are discussed in this update. Thyroid hypofunction has also been known to affect the fertility of women in reproductive age group. With the increasing incidence of infertility and advent of methods to treat them, the early detection and adequate treatment of thyroid hypofunction becomes an unavoidable part of assisted reproductive techniques, in the present day scenario. Even subclinical thyroid disorders can affect the reproductive capacity of non-pregnant women and impact the fetomaternal wellbeing in those who conceive. However, not all cases of subclinical hypothyroidism warrant pharmacological treatment. The guidelines for treatment of subclinical hypothyroidism in the pregnant and non-pregnant states are discussed in detail in this clinical update. An important aspect of reproductive health is family planning, and one of the commonly used means to achieve it is hormonal contraceptives. The interaction of thyroid hormones with hormonal contraceptives and the means of testing thyroid dysfunction in an individual taking hormonal contraceptives have been elucidated in this update.

Critical Issues in Obstetrics and Gynecology - ECAB - E-Book

Endometriosis is a condition that often leads to a variety of symptoms that range from pain complaints to infertility. Endometriosis is also found in women who are asymptomatic. The diagnosis of endometriosis can be made clinically with reliability similar to that of one made surgically. Medical treatment options are effective, as are surgical treatment options. Complications associated with surgery, however, push the balance in favor of medical therapy whenever possible. Based on the body of evidence available at present, women with endometriosis-related complaints should be treated with a first-line medical therapy. If that fails, a second-line medical therapy is warranted under most conditions. Laparoscopic surgery should be reserved for patients in whom second-line medical therapy has failed or is contraindicated by desire to conceive immediately or as soon as possible.