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  • Title: [Amenorrhea and the pill].
    Author: Verdino P, Viard R, Harter M.
    Journal: Lyon Mediterr Med Med Sud Est; 1983 Jan; 19(2):7067-74. PubMed ID: 12279701.
    Abstract:
    Postpill amenorrhea has been variously defined as amenorrhea alone or accompanied by galactorrhea and lasting from 3-6 months after termination of oral contraceptive (OC) use. According to the definition employed, postpill amenorrhea appears to affect from 2-12% of pill users. About 15% of all secondary amenorrhea appears to follow pill use. Some cases of apparent postpill amenorrhea may be due to other causes, such as pregnancy, precocious menopause, Stein-Levanthal syndrome, or tumors, and may be discovered coincidentally on discontinuation of OCs. Cases of amenorrhea with or without galactorrhea accompanied by hyperprolactinemia and of amenorrhea with normal prolactin levels should be differentiated and their etiology evaluated separately. 100 young women using OCs were divided into 3 groups according to the ethinyl estradiol (EE) content of their pills and evaluated for prolactin levels. Average prolactin levels increased significantly in high dose pills, but remained within normal limits. Prolactin secretion was found to increase with duration of pill use in all 3 groups. The mechanism of action of estrogens on prolactin appears to depend on dopaminergic antagonists, which act directly on the pituitary. Ideally, ovulation should be reestablished 3-4 weeks after termination of OC use, with the only anomaly being a slightly longer follicular phase. However, most women ovulate 2-3 months after cessation of oral contraception. In the case of postpill amenorrhea, the plasma level of 17-beta estradiol is normal, but follicle stimulating hormone and luteinizing hormone do not become elevated. The 17-beta estradiol therefore does not fill its positive feedback role but instead exercises an excessive negative feedback. Clomiphene citrate, an antiestrogenic, can often liberate the pituitary from the inhibition. Age, obstetric antecedents, and duration of OC use do not appear related to postpill amenorrhea, but late menarche, irregular menstruation before pill use, estrogen dose, excessive weight loss, smoking, poor hygiene, psychological problems, and use of other drugs are associated with higher
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