Question

Lactational amenorrhoea means
A) Medical termination of pregnancy
B) Oral administration of progesterone
C) Coitus interruptus
D) Intrauterine insemination
E) Absence of menstruation during intense lactation

Answer 1

Lactational amenorrhea is also known as postpartum infertility. It is temporary postnatal infertility that occurs when a woman is amenorrhoeic and fully breastfeeding.

Complete answer:
Amenorrhea means the absence of menstruation. Menstruation does not take place during the pregnancy or at the time of intense breastfeeding. Breastfeeding delays the resumption of normal ovarian cycles by disrupting the pattern of pulsatile release of gonadotropin-releasing hormone (GnRH) from the hypothalamus and thus luteinizing hormone (LH) from the pituitary.

The plasma concentrations of follicle-stimulating hormone (FSH) during lactation are sufficient to induce follicle growth, but the inadequate pulsatile LH signal results in reduced estrogen production by these follicles. When follicle growth and estrogen secretion does increase to normal, lactation prevents the generation of a normal preovulatory LH surge and follicles either fail to rupture or become atretic or cystic.

Only when lactation declines sufficiently to allow generation of a normal preovulatory LH surge to occur, then only will ovulation take place with the formation of a corpus luteum of variable normality. Thus lactation delays the resumption of the normal ovarian cycle by disrupting but not totally inhibiting, the normal pattern of release of GnRH by the hypothalamus.

- Medical termination of pregnancy: It is the termination or removal of the pregnancy/embryo with the help of drugs. The drugs are hormonal in nature.
- Progesterone: It is a female hormone that regulates the menstrual cycle. It is treated with the unusual stopping of amenorrhoea.
- Coitus insemination: It means sexual intercourse which may lead to pregnancy or amenorrhea.
- Intrauterine insemination: It is a fertility treatment in which the sperm is placed inside the uterus in order to bring about fertilisation. It is a technique used for achieving pregnancy.
- So, the correct answer is Absence of menstruation during intense lactation'.

Thus the correct answer is option ‘E’.

Note: In women, hyperprolactinemia is often associated with amenorrhea. This condition resembles the physiological situation during lactation. Mechanical detection of suckling increases prolactin levels in the body to increase milk synthesis and excess prolactin may inhibit the menstrual cycle directly - by a suppressive effect on the ovary and indirectly - by decreasing the release of GnRH.