Amenorrhea, A Case-Based, Clinical Guide.
Amenorrhea, A Case-Based,
Clinical Guide, edited by Nanette
F. Santoro and Genevieve Neal-Perry
New York: Springer Science+Business
Hardcover, 218 pp., $189.00.
Within the first year of private practice, I was faced with an interesting set of cases. A mother and daughter presented on the same day with the same complaint: no menstrual cycle for several months with hot flashes and night sweats. They had been cycling together since the onset of the daughter's puberty, about 1 year earlier. The same symptoms but significantly different ages suggested the probability of different etiologies, different evaluations, and ultimately different treatment approaches. This scenario illustrates the complexity of evaluating amenorrhea.
In Amenorrhea, A Case-Based, Clinical Guide, the editors state that they set out to organize a comprehensive review of amenorrhea that would update clinicians "on our current knowledge regarding normal female reproductive physiology and ... discuss the pathophysiology, diagnostic algorithms, and therapeutic intervention for amenorrhea."
The book begins well, with two chapters on what is normal, followed by chapters addressing the various causes of amenorrhea. Each chapter has a different author or set of authors, so style and content vary. While each chapter uses a clinical case (as inferred from the title) to highlight its topic, some carry it off better than others. In chapter 6, "Hyperprolactinemia and Pituitary Causes of Amenorrhea," the use of a case of a 33-yearold runner illustrates well how easily clinicians could have been led down the wrong road without a thorough evaluation.
The last several chapters were especially informative. Chapter 10, "Clinical Implications of Prolonged Amenorrhea," chapter 11, "Long-Term Implications of Oophorectomy at the Time of Hysterectomy for Benign Disease," and finally chapter 12, "Ethnicity and Amenorrhea," are topics not usually addressed in such a text.
Overall, I believe the editors accomplished what they stated in the preface. It would have been of value, considering their stated audience of practicing clinicians, to have added a summary chapter with the basic overall approach to a patient with amenorrhea. Algorithms for evaluation and triage would have been a useful reference for the busy clinician.
Any physician, obstetrician/gynecologist, internist, family practitioner, or even endocrinologist who encounters female patients would find this book informative and a useful guide for their library.
Reviewed by R. Wayne Inzer, MD
The reviewer, R. Wayne Inzer, MD, is director of the residency program in obstetrics and gynecology at Baylor University Medical Center at Dallas.