Therapy-Orientated Diagnosis of Secondary Amenorrhoea

Abstract

A programme for investigation of secondary amenorrhoea is described, which is based upon a functional classification of the endocrine causes of anovulation. All diagnostic enquiries not directly yielding a therapeutic dividend are excluded from this protocol. Three main categories of amenorrhoea are recognised: primary ovarian disease, hyperprolactinaemia and disorders of gonadotrophin secretion. There are subdivisions of each category, each with its own special diagnostic and therapeutic implications. Initial investigations take 6 weeks to complete and include measurements of follicle-stimulating hormone and prolactin, pituitary radiology and assessment of oestrogen production and of the response to clomiphene. The results of analysis of 75 consecutive cases of amenorrhoea and of 18 patients treated for infertility are presented and a cost benefit analysis applied.

Hyperprolactinaemia in Amenorrhoea - Incidence and Clinical Significance

“…The hyperprolactinaemic patients had even higher responses of FSH and LH than healthy women in early follicular phase of the menstrual cycle. Normal or excessive gonado¬ trophin responses to LH-RH in hyperprolactinaemic patients have also been described by other investigators (Mortimer et al 1973;Jacobs et al 1975;Archer et al 1976). However, Bohnet et al (1976), who used the lower test dose of 25 /ig of LH-RH found impaired or absent responses in 12 of their 17 women with hyperprolactinaemia.…”

“…How¬ ever, Glass et al (1976) detected only 3 pituitary tumours in their 13 hyper¬ prolactinaemic women but these were examined with lateral skull X-rays only, a possible explanation for the low incidence. This stresses the need of both antero-posterior and lateral X-ray projections of the sella turcica in women with amenorrhoea and several investigators also recommend routine tomo¬ graphy of the pituitary fossa of all women with hyperprolactinaemia (Vezina 8c Sutton 1974;Jacobs et al 1975;Nader et al 1976). …”

Hyperprolactinemia and Polycystic Ovarian Syndrome

“…The published incidence of hyperprolactinemia in amenorrheic women varies between 13.4% and 20% . [24][25][26] The difference in rates is likely due to differences in assay methods or conditions under which sera are collected.…”