Abstract
Investigation of 31 patients who developed amenorrhoea following the use of combined oral contraceptives for a period of 3 to 84 months revealed that 55% had a variable degree of oligomcnorrhoea prior to the treatment. It is therefore concluded that an antecedent menstrual dysfunction is a relative contra-indication to treatment with combined oestrogen-gestagen preparations, and that another form of contraception should be recommended in these cases.
In 5 of the 31 patients the amenorrhoea was associated with galactorrhea. None of these patients had any signs of a hypothalamic or hypophyseal tumour, and no explanation can be given for this phenomenon.
Eighteen patients were observed without any subsequent hormonal treatment, 9 patients were treated with clomiphene alone, 1 patient with clomiphene-HCG, 4 patients with HMG-HCG, and in 1 patient a bilateral ovarian resection was performed. These forms of treatment resulted in ovulation in 16 patients and pregnancy in 5 patients. On the basis of both the present and previous investigations the following lines of treatment are recommended. In patients with no sterility problem the management should be expectant, whereas hormonal treatment should be initialed in patients with infertility. Clomiphene either alone or combined with HCG is the treatment of choice in patients with a normal oestrogen level, but in patients with a low oestrogen level treatment with human gonadotropins is preferred.