Oligo-amenorrhea in pill users.

Oligo/amenorrhea most likely occurs in pill-users because of inadequate estrogen stimulation for endometrial proliferation. To stimulate the ability of the uterus to respond to increased estrogen, the woman should be given a higher-dose pill or Premarin 1.25 mg should be added to the 1st 3 weeks of pill use. If the uterus does respond and there is a withdrawal flow, uterine pathology should be ruled out. Withdrawal flow should be stimulated with increased estrogen after 3 months of amenorrhea while taking the pill, provided pregnancy tests are negative. Some women with scant or missed menses are pleased with the pill and should be allowed to continue with it, with check up every 3 to 6 months, if there is no underlying pathology. Most women choose to switch their type of pill for reassurance of withdrawal flow. Pill-users with oligo/amenorrhea should be given pills with a dose of 50 mcg of estrogen. The length of time between discontinuation of the pill and the next menstrual flow is called the post-pill amenorrhea. There is generally a slight delay in the onset of menses when a woman stops the pill. If amenorrhea lasts beyond 90 days, pathology should be considered. Women at greater risk of developing post-pill amenorrhea are those with irregular cycles before beginning the pill. Post-pill amenorrhea or pill-related amenorrhea should be evaluated by considering organ function--uterus; ovaries and the pituitary-hypothalamic axis. If physical exam is normal and pregnancy is ruled out, ovulation can be induced by means of Clomiphene.