Prolonged Amenorrhea Following the Use of Oral Contraceptives

4 cases of prolonged secondary amenorrhea occurring after the discontinuation of a combination-type oral contraceptive are presented. All were nulliparous had taken the drug for 1-4 years and 2 of the patients had an irregular menstrual history. The periods of amenorrhea after stopping the drug lasted for 10-26 months before treatment was attempted. All of the patients were first treated with clomiphene citrate 100 mg. per day for 5 days. Only one patient responding by ovulating. Then all were injected with exogenous gonadotropins in response to which all ovulated and 1 became pregnant. It is reported that researchers believe this prolonged amenorrhea after discontinuation of combination pills is caused by the alteration in the cyclic normal functioning of the hypothalamic-pituitary axis by the drug in that the midcycle LH peak is suppressed for a prolonged time and reverses slowly. This low gonadotropin excretion is responsive to exogenous gonadotropin therapy.