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After Oral Contrceptive
After Oral Contrceptive
AMENORRHOEA
- TREATMENT AND
Rodney P. Shearman Department of Obstetrics and Gynaecology University of Sydney, 2006, Australia
ABSTRACT
Clinical data are presented on 103 patients with secondary amenorrhaea of more than 12 months duration developing after treatment with oral cantmceptives. Four appeared to have a premature menopause; two so far, have radiological evidence of pituitary turnour; in the remainder the level of disturbance was apparently the hypothalamus. The only common abnormality on physical examination was galactorrhoea, which was present in 23 women. Thirty patients had a history of persistent menstrual irregularity before taking oral contraceptives, while five more had had previous episodes of menstrual irregularity. Sixty-eight had a history of regular menstruation before treatment. Twenty-six of 61 treated patients conceived as a result of treatment. Thirty-five underwent spontaneous cure, and in a further 12 patients,owlatory menstruation returned after induced pregnancy. However, 31 had persistent amenorrhoea, and amenorrhoea returned in a further 14 after induced pregnancy.
Accepted
for publication
December
3,
1974
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123
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INTRODUCTION Earlier with oral secondary history reports from this department amenorrhoea (1,2,3). Uncertainty have described durotion a series after of patients and of
of at least 12 months
stopping effects
contraceptives
natural
of this condition
and pregnancy. the findings menstrual of spontaneous in 103 patients history, cure, with particular with oral and
to their
contraceptives,
response to treatment,
of induced pregnancy
All oral
103 patients
of secondary
amenorrhoea time
which
The
in this series was seen for the first is 18 months, menstrual The previous
period of follow-up
at presentation,
are shown in
Treatment
Number
of patients 73 21 9 (5) *
Parity
Number
of patients 81 16 6 103
26-35 l-3
103
of 12-18
months
secondary
omenorrhoea
with
to regular regular
oral contraceptives.
TWO
had initially
by irregular
before starting
oral contraceptives.
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Length
of Treatment
Length
of Subsequent Amenorrhoea
Number 19 13 40 22 9 -
of Patients
Number 76 15 12
of patients
103 -
Total
103 -
Type
Unknown Combined Combined Sequen tia Pi I I (19-nor gestogen) gestogen)
Number
of Patients 9 a4 2 8
Pi I I (17-acetoxy
I
Total
103
disease. oral
Two
of hot flushes,
treatment
controcepof cloudy
hirsute,
the secretion
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CONTRACEPTION
while
initial
and,
follawTwo
evidence
ovarian This
was studied
in 84 potienk urinary
Number
12 (4) + 53 C(ll) 84 *
+ *
premature
with
showed no response to this dose. and two of these patients evidence of premature Eight treated
Four of these,
complained
of hot flushes.
in two women.
gonadatrophins; oestrogens
response,
as an increase
had on excessive
(5) (Table
126
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luteinising
The response of serum luteinising hormone to an introvenous bolus of hormone releasing hormone to one patient is shown in Figure 1.
LHRH
20&gI./.
Jl
0 30 60 TIME
90
120
(minutes)
Figure 1. Serum LH after intro venous administration of LHRH. had shown a normal response to gonadotrophin stimulation. Results of treatment
This potient
The only treatment relevant is induction of ovulation. It is our practice to attempt ovulation induction only in those women currently concerned by infertility, Sixty-one patients hove been treated, all initially with clomiphene citmte. Thirty-four appeared to ovulate, and twenty-four pregnancies in twentytwo patients resulted. Seven patients who failed to respond to clomiphene were treated with human pituitary gonadotrophins. All ovulated and there were 6 pregnancies in 4 patients. The results are wmrnarised in Table V.
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11 NO. 2
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TABLE Results
V.
Number Number
61
apparently Number
34
of patients 22 * 4+
conceiving
2 patients
conceived
twice
+2
with
patients
conceived
twice
with
clomiphene
gonadotrophins
Results
of FoIIow-UD These are summarised in Table Vi. Ninety-three patients have been between
followed
up,
presentation
varying
18 months
after
in 31 patients
induced
amenorrhoea
is 132 months. have undergone menstrual spontaneous after cure, induced and a further pregnancy. 12
of normal
pattern
Two patients
are currently
pregnant,
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TABLE
VI
Lost to follow-up Persistence Spontaneous Spontaneous Recurrence Currently of amenorrhoea cure cure after induced after pregnancy induced pregnancy
10 31 35 12 * 14* 2
of amenorrhoea pregnant
hod recurrence
of amenorrhoea
after
first
induced
and spontaneous
cure after
second induced
pregnancy.
DISCUSSION It is still not possible to be absolutely amenorrhoea. sure what role the oral At least 6 patients contraceptives
play in the genesis of secondary reasons for amenorrhoea, of pituitary found oral tumaur. patients in other
4 because of presumed premature of these 2 conditions secondary belief at this centre with
amenorrhoea
indicated
in our total
patients of patients.
(6), this
prospective
the pill
by themselves
Larsson-Cohn
discontinuing Pettersson
six months
o study of a separate
found a figure
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CONTRACEPTION
The only reliable his colleagues stopping with loss. studied (9).
comparative
studies
and
They indicate
that the genesis of amenorrhoea multifactorial, menstrual in 16%of causal association irregularity
in patients
is frequently a probable
between
contraceptives
and secondary
amenorrhoeic
patients
had persistently
irregular
cycles
before
taking
oral
a greater
proportion
23 had prior
but 68 of the 103 women had an impeccable it may be reasonable, for patients with a history
to treatment. with
of irregular
menstruation,
regular
cycles are not immune to this complication. had taken the pill for only 3 to 6 months. between duration of
of a relationship amenorrhoea.
can be read into the data in Table the statement (10). be expected that sequential Th e incidence
preparations
of types of tablets
these patients
compounds in
with (Table
coincidental
premature of This is
compatible
to be expected from the site of action The data permit treated had patients, only a chance effect restoration real difficulty by 2 patienk. followed clomiphene, recurrence with restoration
contraceptives. Of 61
some conclusions
an accurate
at an individual induced
by recurrence
Of 93 patients While
many of
130
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secondary
amenorrhoea, interval
spontaneous
which
to the subjective
of an individual
REFERENCES
1.
R.P.
Amenorrhoea (1966).
after
treatment
with
oral
contraceptives.
2.
Shearman, treatment
Investigation oral
developing
after
contraceptives. secondary
3.
Shearman, therapy
Prolonged
amenorrhoea Lancet
- natural R. P.
history.
64-66
(1971).
4.
Shearman,
ovarian ii:
stimulation
heterologous
1115-1116
The enigmatic
analysis (1972).
contraceptives,
secondary
amenorrhoea
Gynaec. U.
Comm.
7.
The length
three
menstrual
contraceptive
Acta obstet.
gynec.
8.
F.
,
1.
Fries,
H.
and Nillius,
5. J.
Incidence
and prevalence
(1973). Nillius, 11. S. J. and Pettersson, loss. F. Epidemiology of etiology J. Obstet. of secondary special Gynec. regard 118: 473-479
9.
Fries,
amenorrhea. (1974).
evaluation
with
to psychogenic
factors
Amer.
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10.
Macleod, Amer. J.
S. C., Obstet.
Parker, Gynec.
A.S.
and Per/in,
I.A. (1970).
The oversuppression
syndrome.
106: 359-364
11.
Jung,
C. G.
Memories, p. 17.
Collins
and Routledge,
London 1963,
132
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