Amenorrhea Following Use of Combined Oral Contraceptives

. 249 cases of long‐standing amenorrhea after the use of oral contraceptives have been examined clinically, and their hormonal excretion in the urine has been determined. In April 1972 a follow‐up of the patients was undertaken and 178 had answered before May 1, 1972. 59.3% of the patients had recovered spontaneously, 38 of them had amenorrhea from 6 to 12 months and 69 more than 12 months. 72 patients still had amenorrhea at the time of the follow‐up. Of the patients 122 probably had amenorrhea as a direct result of the treatment. In the other patients other factors could be taken into consideration, as being the cause of amenorrhea. Three patients had a premature menopause. In our series 35.4% of the patients had had menstrual irregularities antedating the use of oral contraceptives. The frequency of previous oligo‐amenorrhea among post‐“pill” amenorrhea cases is obvious and such women would be better to choose another kind of contraception. The longest period of amenorrhea before remission was 39 months. A low excretion of low polar oestrogens is associated with a long duration of the amenorrhea. No treatment should be used in patients with a moderate excretion of oestrogens in the urine except for those who desire to become pregnant. Treatment with clomiphene or clomiphene and HCG is then the method of choice. Patients with a low excretion of oestrogens in the urine can be treated with low doses of ethinyoestradiol (10–20 μg daily) in order to avoid atrophy of the genital organs and to stimulate the FSH and LH releasing factor. If they want children, HMG followed by HCG should be used or FSH‐LH releasing hormones.