Neuroendocrine dysfunction in galactorrhea-amenorrhea after oral contraceptive use

John E. Tyson, Barbara Andreasson, Janice Huth, Beverly Smith, Howard Zacur

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Abstract

Nonpuerperal galactorrhea and amenorrhea have been reported following the use of oral contraceptives. Treatment of this condition with ergot alkaloids has proved to be of great therapeutic value. Pretreatment plasma hLH and hFSH concentrations in 13 women with postpill galactorrhea-amenorrhea (PPGA) were 6.6 ± 0.6 (SE.) and 5.0 ± 0.8 mIU/ml, respectively. The mean prolactin concentration was 80.7 ± 13.2 ng/ml. After complete evaluation in which diagnostic evidence of pituitary tumor was absent, the patients were treated with ergocryptine (CB-154). The mean hPRL concentration at 14 days of therapy was 7.8 ± 1.9 ng/ml. Cyclic gonadotropin secretion resumed in all but one instance, ovulation was confirmed on the basis of a bi-phasic temperature chart and in 5 cases, endometrial biopsy. Measurement of serum dopamine-beta-hydroxylase (DBH) activity indicated a significant decline at the end of 8 weeks of CB-154 therapy. The fall in hPRL was not necessarily associated with a fall in DBH. The majority of women in this study exhibited a consistent personality suggesting varying degrees of anxiety unrelated to the PPGA and usually antedating the use of oral contraceptives. PPGA was found in women without hyper-prolactinemia, but altered hPRL secretion was evident in all instances. The data suggest that the disorder of cyclic gonadotropin secretion is related to altered hPRL secretion, but the mechanism is possibly related to a catecholamine abnormality. The data support the presence of an inherent cyclic mechanism for the secretion of gonadotropins. CB-154 therapy does not affect conception, and no teratogenic effects were observed in 2 infants born to women who had received CB-154 during the first 40 days of gestation.

Original languageEnglish (US)
Pages (from-to)1-11
Number of pages11
JournalObstetrics and gynecology
Volume46
Issue number1
DOIs
StatePublished - Jul 1975

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ASJC Scopus subject areas

  • Obstetrics and Gynecology

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