Etiology, clinical features and prognosis in secondary amenorrhea
Hirvonen, E.
International Journal of Fertility 22(2): 69-76
1977
ISSN/ISBN: 0020-725X PMID: 20414 Document Number: 119272
356 15-35 year old patients with secondary amenorrhea were studied. In all cases amenorrhea had persisted for 12 months or more. The best prognosis was found in patients with postpill amenorrhea with 95% recovery in 6 years. Lowest recovery rates, 56-61%, were seen in patients with anorexia nervosa and idiopathic functional amenorrhea. Of those with an organic etiology, ovarian failure was diagnosed in 22 patients who showed no follicular response after large doses of human menopausal gonadotropin (HMG). Relative ovarian failure was diagnosed in 5 patients who responded to HMG, the Stein-Leventhal syndrome was found in 9 patients, an adrenal adenoma was present in 1 patient; a pituitary tumor was diagnosed in 1 patient, 3 patients had organic brain lesions, and intrauterine synechiae were present in 3 patients. 93 of the 308 patients with functional amenorrhea gave a history of self-induced weight loss. In 56 patients, amenorrhea began after oral contraceptives ceased. 17 of 22 patients with anorexia nervosa were in the recovery stage. Psychogenic factors were present in 55 cases. 18 patients had galactorrhea and amenorrhea. In 5 of these the symptoms appeared after contraceptive treatment was stopped; they were classified as functional. No known etiological factor was found in 62 patients. The principal treatment was estrogen-progesterone substitution. Clomiphene, 100 mg/day for 5 days, was given to 105 patients with functional amenorrhea. Patients with infertility should be treated 1st with clomiphene-human chorionic gonadotropin or tamoxifen. If no response is obtained, bromocriptine with clomiphene are recommended. Induction of ovulation with exogenous gonadotropin was carried out for patients who did not respond to clomiphene. 27 healthy children were born after gonadotropin-induced ovulation.