In conclusion, although there are changes in the hypothalamic pituitary axis in terms of release of FSH and LH resulting in anovulation in women on oral contraceptives, the evidence to date does not support a cause and effect phenomenon. On the basis of both epidemiologic as well as biochemical studies, the etiology of secondary amenorrhea is diverse. This serves only to indicate that amenorrhea is a symptom, not a diagnosis. It appears at the present time that amenorrhea following the use of oral contraceptives should indicate only the preceding temporal use of exogenous steroids without implication as to a cause of the amenorrhea. Investigation should be aimed at determining the underlying cause of the amenorrhea.
PIP: The incidence and endocrinologic findings in women with spontaneous amenorrhea were compared to the findings in women with amenorrhea occurring after oral contraceptive (OC) use. Attention in this review is directed to the following: epidemiology of secondary amenorrhea; other factors related to the occurrence of amenorrhea; duration of amenorrhea; endocrinology of amenorrhea; progesterone challenge test; endogenous follicle stimulating hormone (FSH), luteinizing hormone (LH), and the gonadotropin response to gonadotropin releasing hormone (GN-RH); effects of OCs on FSH and LH response to GN-RH; gonadotropin responses to estrogen and clomiphene citrate; and return of ovulation and/or menstruation after OCs. Studies of spontaneous amenorrhea in the normal population indicate an incidence of between 0.7-1.0%. The highest incidence of spontaneous amenorrhea has been observed in women under severe stress, e.g., concentration camp inmates. The occurrence of post OC amenorrhea has been estimated to range from 0.2-3.1% depending upon the definition of duration of amenorrhea. A recent survey of amenorrhea in Uppsala County, Sweden found that there were only a few statistically significant relationships in the population aged 25-39. In this study a lower incidence of amenorrhea was found in married women compared with unmarried women. The reasons for the differences in incidence figures from various authors may be because of the heterogenicity of patients. It may also be because other factors that might result in amenorrhea may have occurred before or during OC use, with the net result being a temporal relationship between the use of the steroidal contraceptive and the occurrence of subsequent amenorrhea. There is evidence that the age of the woman using OCs may cause variation in the incidence of subsequent amenorrhea. The body body weight of the individual may be a significant factor in the development of amenorrhea. There appears to be no correlation between the duration of OC use and the occurrence of amenorrhea. There does not seem to be any significant difference between the occurrence of spontaneous and post OC amenorrhea when viewed from epidemiologic studies, but there are various endocrinopathies that require further investigation. There are changes in the hypothalamic pituitary axis in terms of release of FSH and LH resulting in anovulation in women on OCs, but the evidence thus far fails to support a cause and effect relationship. On the basis of epidemiologic and biochemical studies, the etiology of secondary amenorrhea is diverse. Amenorrhea appears as a symptom, not a diagnosis. At this time it seems that amenorrhea following OC use should indicate only the preceding temporal use of exogenous steroids without implication as to a cause of the amenorrhea. Research should be directed at determining the underlying cause of the amenorrhea.