GYNECOLOGIC ENDOCRINE EMERGENCIES

THE physician dealing with gynecologic and obstetric patients frequently must manage emergencies resulting from faulty endocrine homeostasis (eg, dysfunctional uterine bleeding). In earlier portions of this series, reference had been made to particular problems in the diagnosis and treatment of certain endocrine emergencies as they occur in pregnancy. In this section, we review disruptions of normal gynecologic endocrine function encountered during the reproductive years and early pregnancy: treatment of dysfunctional uterine bleeding, undesirable sequelae of ovulation induction, and finally, a few comments about the use of hormonal agents during gestation.Dysfunctional Uterine BleedingEtiology.—Dysfunctional uterine bleeding (abnormal uterine bleeding caused by endocrine factors, often defined as such because of its irregular timing and the absence of nonendocrine lesions) is generally synonymous with anovulation. Occasionally, dysfunctional bleeding associated with ovulation does occur, viz, ovulation bleeding, inadequate corpus luteum, prolonged corpus luteum (Halban disease), and irregular shedding.1Diagnosis.—Differentiating dysfunctional