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Pregneninolone may be used for the treatment of oligomenorrhea and secondary amenorrhea in adolescent girls. It is beneficial for some selected patients, particularly those with severe nervousness or dysmenorrhea when advice and observation do not suffice. For the patient who obtains relief from the use of pregneninolone, its administration is believed to be preferable to parenteral endocrine therapy or to large dosage with sedatives or analgesics which may be harmful. This hormone is given to prevent the occurrence of symptoms rather than to relieve those present. The initiation of bleeding has a pyschological advantage. Forty-six girls were treated. Twenty-nine, or 87 per cent, of the thirty-three girls with cycles of three months or less were improved. Pregneninolone is not recommended for those with cycles of longer than six months or for primary amenorrhea, as results were poor in these groups. Although the effect of taking pregneninolone tablets is largely temporary, a follow-up record of thirty patients with improved menstrual cycles showed that twelve, or 40 per cent, continued to menstruate regularly and approximately on time during the six months following completion of treatment.

Objective The aim of this study was to evaluate the prevalence of hyperprolactinemia in adolescents and young women with menstrual problems. Study Design This study included 1704 young women with menstruation-related problems. The patients were classified into group I (age, 11-20 years) or group II (age, 21-30 years); the prevalence of hyperprolactinemia was analyzed according to age and categories of menstruation-related problems. Results For primary amenorrhea and oligomenorrhea, the prevalence of hyperprolactinemia was low in both groups. However, hyperprolactinemia was a relatively common cause of secondary amenorrhea (5.5% for group I and 13.8% for group II, respectively); it was more frequent in group II ( P = .001); the prevalence of prolactinoma was also higher in group II ( P = .015). For abnormal uterine bleeding, hyperprolactinemia was more common in group II (2.6% for group I and 9.4% for group II; P Conclusion Hyperprolactinemia is not rare in young women with menstruation-related problems; its prevalence varies according to age and manifestations.

Balanced translocations involving an X chromosome and an autosome have been infrequently reported. A patient with a balanced X-autosome translocation 46,X,rcp(X;4)(q26;q21) who exhibited early secondary amenorrhea and gonadal dysgenesis is described. In an effort to explain the varied phenotypic expressions encountered in female cases of balanced X-autosome translocations, evidence will be provided to suggest an extension of the minimal limits of the "critical region" in the long arm of the X chromosome from A-B, as described by Sarto and associates, to new minimal limits C-D.

Endocrinologic studies were done on a patient with “gonadotropin-resistant ovaries” syndrome presenting with secondary amenorrhea, increased secretion of gonadotropins, and unstimulated ovarian follicles. The feedback effects of estrogen upon the hypothalamic pituitary axis seemed to be present. Plasma levels of estradiol and estrone were in the low normal range. The levels of androgens in the plasma were slightly elevated, and the elevated levels appeared to be ovarian in origin. Clomiphene did not alter the levels of follicle-stimulating hormone (FSH) and luteinizing hormone significantly but increased the levels of estrone and estradiol. Histologic confirmation of unstimulated follicles and elevated levels of the gonadotropins, particularly FSH, are essential for diagnosis.

During the period January, 1978 to June, 1979, a total of 900 college students was seen in a university student health center. Among these, 14.6% (131/900) had menstrual disorders. Oligomenorrhea or secondary amenorrhea, the chief complaint in 72.5% (95/131) students, accounted for 10.6% (95/900) of the total population. When a selected group of students with oligomenorrhea/amenorrhea was investigated, most had elevated levels of luteinizing hormone (LH) and normal/low levels of follicle-stimulating hormone (FSH) suggestive of polycystic ovary syndrome (PCO). The significance of these findings in the development of oligomenorrhea/amenorrhea and PCO under stress is discussed.This paper examines the prevalence and types of menstruation disorders among 900 female students attending the student health service of a large coeducational university during the period 1/78 to 6/79. Each student was subjected to a careful history and physical examination as well as counseling with regard to the physiology of menstrual cycle and possible causes. Laboratory tests for pituitary, ovarian, thyroid, and adrenal function were performed, and blood samples were collected and assayed for various hormones. Of the 900 students, 131 (14.6%) complained of menstrual disorders unrelated to oral contraceptive use. 90 (72.5%) out of the 131 had oligomenorrhea or secondary amenorrhea and accounted for 10.6% of all women visiting the student health service. The onset of oligomenorrhea or amenorrhea was not associated with oral contraceptive use. Based on clinical features and gonadotropin values, 3 groups of oligomenorrhea/amenorrhea patients were identified: group 1, hypogonadotropic associated with simple weight loss (n=1); group 2, normagonadotropic of unknown etiology (n=6); and group 3, elevated luteinizing hormone with normal/low follicle-stimulating hormone suggestive of polycystic ovary syndrome (PCO) (n=12). The true incidence of PCO in this series is not known because of the incomplete endocrine profile of the college students. Stressful events (physical, emotional, social) and/or the competitive life style at the college campus may contribute to the incidence of oligomenorrhea/amenorrhea, but carefully designed prospective studies are needed to substantiate this.

Thirty-five patients with secondary amenorrhea and an associated gonadotropinestrogen deficiency were treated in 233 cycles with clomiphene, 100 mg. per day for 5 days each cycle. The pretreatment mean duration of amenorrhea was 2.4 years. Eighty per cent of the patients ovulated in one or more cycles of treatment and 35 per cent became pregnant. No correlation was found between the pretreatment Metopirone pituitary function test results and the success of clomiphene treatment. This form of therapy is discussed. (See addendum.)

Twenty-six patients with secondary amenorrhea and inappropriate lactation have been studied. There was no apparent cause in 8, while in 18, precipitating factors were present. Urinary estrogens were low, and assay of human growth hormone (HGH) in 9 patients did not reveal a constant pattern. Seventeen patients submitted to diagnostic gonadotropin stimulation and each showed a response compatible with potentially normal ovarian function. Nine patients without detectable lesions have been, or are being, treated with clomiphene citrate and/or human gonadotropins. All 9 have or had apparent ovulation, and 5 so far have conceived. Lactation has stopped in each of these 9 patients, but in none of those untreated.

A female, aged 31, who had amenorrhea for ten years, received 25,500 rat units of antophysin over a period of eleven months in manner stated above, had four menstrual or pseudomenstrual periods, finally conceived and gave birth to a living child. The points of interest in this case are: 1. Menstruation or pseudomenstruation was restored after a ten-year period of secondary amenorrhea. 2. Patient conceived and carried to full term, giving birth to living child. 3. Despite the absence of a cyclic curve of estrone, treatment was attempted. 4. Patient was treated over a period of eleven months. Had treatment ceased at six months or less, the hormonal product would probably have been blamed for failure. 5. Treatment was given at thirty-day intervals, establishing a so-called cycle for treatment. 6. This case is not reported in order to represent the sole type of treatment for all cases of secondary amenorrhea. However, it suggests that we might some day arrive at the proper dosage and proper time of cycle for hormonal treatment of amenorrhea.

A treatment plan utilizing placebo, cyclical steroid therapy, clomiphene citrate, and human pituitary gonadotropin is outlined for the induction of ovulation in carefully selected potentially fertile women. Such a plan minimizes any risk with the potentially hazardous ovulatory stimulants. A total of 220 patients with secondary amenorrhea were studied and an etiologic basis for the condition was found in 98 (45 per cent). Of the 220, 190 were found suitable for the induction of ovulation, and together with 145 patients with oligomenorrhea and 17 patients with anovulation, entered the treatment plan. Ovulation was successfully induced in 351 of the 352 (99.5 per cent) and pregnancy in 218 (61.9 per cent). The success rates for the agents in the various conditions are presented and discussed.

A group of ninety unselected women with secondary amenorrhea of at least six months' duration were studied retrospectively. By the use of intramuscular progesterone in oil, it was possible to categorize these patients according to their positive or negative uterine bleeding response. LH, FSH, and estradiol values in the 63 patients of the positive category had a log-normal distribution. LH values were found to be composed of two different populations; FSH and estradiol values were composed of only one population. Based on these LH determinations the entire positive category was then divided into two groups. Patients with high levels of LH (Group I) were clinically diagnosed to have polycystic ovarian disease. Patients with normal levels of LH (Group II) were diagnosed to have hypothalamic-pituitary dysfunction. The 27 patients who failed to have withdrawal uterine bleeding were placed in the negative category. These patients also were shown to have a log-normal distribution for LH, FSH, and estradiol. In contrast to the patients in the positive category, FSH values in these patients were made up of two different populations whereas LH and estradiol values showed only one population. Based on the FSH values these patients were divided into two groups, one with low and normal levels of FSH (Group III) and the second population with high levels of FSH designated as Group IV. Group III represented those patients with hypothalamic-pituitary failure and patients in Group IV were those with ovarian failure. Serial determinations of LH, FSH, and estradiol done prospectively on five consecutive days in 19 of the 90 patients did not give any further information in differentiating among the four groups.

One hundred sixty-seven women with secondary amenorrhea were observed from six months to four years. In 66 patients, the amenorrhea followed the discontinuation of oral contraceptives (postpill) while in the remaining 101 the amenorrhea was not temporally pill related (non-postpill). Galactorrhea was present in 43 (65%) of those with postpill amenorrhea and in 32 (32%) of those with non-postpill amenorrhea (p less than 0.001). Tomography of the sella turcica was performed in the 75 women with galactorrhea and in the 35 without galactorrhea who did not have withdrawal uterine bleeding following progesterone administration and who had low or normal serum follicle-stimulating hormone levels (hypothalamic-pituitary failure). Forty of the 75 patients with amenorrhea and galactorrhea had radiographic evidence of a pituitary tumor whereas only eight of 35 patients with hypothalamic-pituitary failure without galactorrhea had an abnormal sella turcica (p less than 0.01). The incidence of radiographic abnormalities in those with galactorrhea was similar in both the postpill and non-postpill groups.

Androgen-producing ovarian tumors are rarely recognized as a cause of delayed or arrested puberty, despite their frequent association with secondary amenorrhea in the older patient. A case is discussed of a Sertoli-Leydig cell tumor in an 18-year-old girl resulting in arrest of breast development and primary amenorrhea.

Twenty-five patients with secondary amenorrhea or oligomenorrhea were studied with buccal smear, nuclear sex analysis, and leukocyte karyotyping. XX/XO Chromosomal mosaicism was found in 3 patients (12 per cent). The data, although preliminary, suggest that a buccal smear should be performed on all patients with secondary amenorrhea of greater than 6 months' duration or on those with oligomenorrhea.