Step twoexclude hyperthyroidism and hyperprolactinemia

1. Hypothyroidism and hyperprolactinemia can cause amenorrhea. These disorders are excluded with a serum thyroid-stimulating hormone (TSH) and prolactin.

2. Hyperprolactinemia. Prolactin inhibits the secretion of gonadotropin-releasing hormone. One-third of women with no obvious cause of amenorrhea have hyperprolactinemia. Mildly elevated prolactin levels should be confirmed by repeat testing and review the patient's medications. Hyperprolactinemia requires an MRI to exclude a pituitary tumor.

Drugs Associated with Amenorrhea

Drugs that Increase Prolactin

Antipsychotics Tricyclic antidepressants Calcium channel blockers

Drugs with Estrogenic Activity

Digoxin, marijuana, oral contraceptives

Drugs with Ovarian Toxicity

Chemotherapeutic agents

Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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