POPLINE Document Number: 017099
Author(s):
March CM
Mishell DR
Source citation:
In: Crosignani PG, Rubin BL, ed. Endocrinology of human infertility: new aspects. London, England, Academic Press; New York, Grune and Stratton, 1981. :207-19. (Proceedings of the Serono Clinical Colloquia on Reproduction No. 2)
Abstract:
365 patients who attended an endocrine-infertility service between January 1970-July 1980 were studied. The group was divided as to whether their amenorrhea occurred after using oral contraceptives (OCs) or whether it was unrelated to drug usage. Serum samples were obtained from all patients for follicle stimulating hormone (FSH) and luteinizing hormone (LH) determinations. At the initial visit 100 mg of progesterone in oil was administered intramuscularly (IM). Those patients who had no withdrawal bleeding within 2 weeks of the initial injection received an additional 200 mg. Of 100 patients who asked to conceive, 80 were treated with clomiphene citrate beginining at 50 mg/day for 5 days and then, if ovulation did not occur, the dose was sequentially increased in 50 mg/day increments to a maximum of 250 mg/day for 5 days. 30 patients who had amenorrhea and galactorrhea were tested with 2-Br-alpha-ergocryptine and 36 of those who did not ovulate following treatment with the highest dose of clomiphene plus HCG received Human Menopausal Gonadotropins (HMG)-HCG. Of the 64 with amenorrhea without galactorrhea 65.6% had uterine bleeding after IM progesterone administration. Patients with post OC amenorrhea have some characteristics similar to, and some different from, those of patients with secondary amenorrhea unrelated to OCs in that both have a large incidence of oligomenorrhea but only post OC users have galactorrhea and hyperprolactinemia. OCs were found to be linked with a risk of amenorrhea and galactorrhea and can stimulate the growth of a dormant pituitary microadenoma. Also the incidence of radiologic evidence of pituitary tumors was significantly higher in the post OC galactorrhea group than the amenorrhea-galactorrhea group not associated with OC use. High percentages of women in both groups had evidence of estrogen deficiency, in the post OC group 47.6% and in the non OC group 41.5%, but etiology was different in each group. The response to ovulation-inducing drugs was similar in the 2 groups with all but 1 of the 30 patients who received bromocryptine ovulating and all 36 who received HMG having ovulatory response. There was no significant difference in ovulation rates when the patients who had withdrawal bleeding following progesterone were compared. The optimal method of ovulation induction is best selected by determining whether the patient has galactorrhea and if there is evidence of estrogen deficiency as determined by failure, to have progesterone-induced withdrawal bleeding.
Keywords:
Oral Contraceptives, Side EffectsIndex page
Contraceptive Agents, Female
Amenorrhea
Menstruation Disorders
Follicle Stimulating Hormone
Luteinizing Hormone
Prolactin
Gonadotropins, Pituitary
Gonadotropins
Hormones
Contraception
Clomiphene
Gonadotropins, Chorionic
Hypothalamus
Galactorrhea
Central Nervous System Effects
Bleeding
Contraceptive Methods
Side Effects
Contraceptive Safety
Safety
Public Health
Health
Contraceptive Agents
Family Planning
Diseases
Endocrine System
Physiology
Biology
Pituitary Hormones
Fertility Agents
Reproductive Control Agents
Central Nervous System
Puerperal Disorders
Signs and Symptoms
Treatment