Secondary amenorrhoea and oral contraceptives.

ABSTRACT

PIP: 87 cases (Group 1) of secondary amenorrhea starting immediately after treatment with estrogen-gestagen tablets and 227 cases (Group 2) with secondary amenorrhea not preceded by hormonal therapy were studied. In all cases the amenorrhea had been of more than 6 months' duration. Endocrine studies included urinary output of 17-keto steroids, 17-ketogenic steroids, and total gonadotropins. Basal metabolic rate, protein bound iodine (PBI), and triiodothyronine were measured and the percentage of eosinophilic cells in vaginal scrapings was assessed. Radiological examination of the sella turcica and visual field testing were carried out. Group 1 patients averaged 4 years older than those in Group 2. In 28% of cases, treatment with oral contraceptives had been given for menstrual irregularities only. Oligomenorrhea had been present previously in 30% of Group 1 and in 46% of Group 2 patients (p equals .05). Increased urinary output of 17-keto steroids and 17-ketogenic steroids, and of hirsutism were slightly higher in Group 2. Eosinophilic cells in vaginal scrapings were low in 20% of Group 1 patients and in 46% of Group 2 patients. Psychogenic factors or severe stress had been noted in 26% of Group 1 and in 56% of Group 2 patients (p equals .0125). Galctorrhea had occurred in 1 patient in Group 1 and in 4 in Group 2. Spontaneous recovery of pituitary-ovarian function occurred in 40% of both groups. Type of menstrual pattern before therapy in Group 1 did not alter spontaneous re covery rates. But when the interval between menarche and start of hormonal therapy had been shorter than 5 years the spontaneous recovery was greater, 32 vs. 42%, when it had been longer than 5 years. Other predisposing factors may explain the development of secondary amenorrhea in about 50% of cases occurring after treatment with oral contraceptives . In the other 50%, a causal relationship of the therapy is suggested.