Management of chronic anovulation

A. Adequate estrogen and anovulation is indicated by withdrawal bleeding with the progesterone challenge test.

B. Often there is a history of weight loss, psychosocial stress, or excessive exercise. Women usually have a normal or low body weight and normal secondary sex characteristics.

1. Reducing stress and assuring adequate nutrition may induce ovulation.

2. These women are at increased risk for endometrial cancer because of the hyperplastic effect of unopposed estrogen.

3. Progesterone (10 mg/day for the first 7-10 days of every month) is given to induce withdrawal bleeding. If contraception is desired, a low-dose oral contraceptive should be used.

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