Management of post-pill XXXX .

@entity1 @entity4089 @entity3610 @entity11157 @entity251 @entity353 @entity6726 @entity2847 @entity172 @entity4082 @entity1420 @entity1278 @entity53 @entity43 @entity2670 @entity10 @entity2588 @entity3427
Persistent @entity2588 , an uncommon sequela of oral contraceptive (OC) use, would not be a major problem except for the fact that an estimated 50 million @entity1 worldwide use OCs. Following OC use, @entity1 often experience some delay in resuming normal menses, but according to most studies, fewer than 1% fail to begin menstruating regularly within 6 months. In about 1/2 of this small percentage of @entity1 , failure to resume normal menses within 6 months is caused by an identifiable underlying disorder. The remaining 1/2 are considered to have "postpill @entity2588 ," the result of a disruption of the normal hypothalamic-pituitary-ovarian feeding mechanism, which may be reversible with appropriate treatment. In evaluating @entity1 with postpill @entity2588 , it is important to rule out @entity11157 , @entity3610 , @entity353 , and @entity4089 before arriving at a diagnosis of @entity2588 . Prior to 6 months, detailed laboratory evaluation is not indicated, but after 6 months of @entity2588 , the history and physical status should again be carefully evaluated. Any history of weight change, @entity6726 , @entity3427 , @entity10 , or "hot flashes" should be noted. On examination, evidence of @entity3427 , virilization, expressible @entity6726 , or @entity2670 should be sought. The presence of any of these findings warrants laboratory testing. Pregnancy should always be excluded before further testing. If the @entity1 shows no clinical evidence of @entity11157 , @entity3610 , @entity1278 , or @entity4089 , or if laboratory evaluation fails to confirm clinical suspicions, it is appropriate to wait another 6 months before further evaluation. These disorders may be differentiated from @entity2588 by measuring serum levels of gonadotropins, @entity53 , @entity251 , and prolactin and by sella polytomography. It is important to define whether the treatment objective is resumption of a normal menstrual pattern or restoration of fertility, or both, for therapy will differ depending upon the objective. Ovulation can be induced with @entity4082 or @entity2847 in 50-75% of @entity1 . Rarely, @entity1 menopausal gonadotropin and @entity1 chorionic gonadotropin may be needed. If fertility is not an issue, cyclic @entity172 and @entity1420 may be useful to maintain adequate @entity172 effects but will obviously continue to suppress the @entity43 .
