Amenorrhea medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]
Overview
Pharmacologic medical therapy is recommended among patients with hypothalamic causes, pituitary causes, ovarian insufficiency, and chronic anovulation. The general principle of the treatment in amenorrhea is sex hormones replacement therapy, mostly with suitable forms of estrogen and progesterone.
Medical Therapy
- Pharmacologic medical therapy is recommended among patients with [hypothalamic] causes, [pituitary] causes, [ovarian] insufficiency, and chronic anovulation.
Amenorrhea
- 1 - Hypothalamic causes
- 1.1 Adult
- Preferred regimen (1): Alora 0.05, 0.075, and 0.1 mg transdermal daily, applied twice weekly PLUS Medroxyprogesterone acetate 10 mg PO for 12 days each month
- Preferred regimen (2): Climara 0.025, 0.05, 0.075, and 0.1 mg transdermal daily, applied once weekly PLUS Medroxyprogesterone acetate 10 mg PO for 12 days each month
- Preferred regimen (3): Esclim 0.025, 0.0375, 0.05, 0.075, 0.1 mg transdermal daily, applied twice weekly PLUS Medroxyprogesterone acetate 10 mg PO for 12 days each month
- Preferred regimen (4): Vivelle-dot 0.037, 0.05, 0.075, 0.1 mg transdermal daily, applied twice weekly PLUS Medroxyprogesterone acetate 10 mg PO for 12 days each month
- Preferred regimen (5): Premarin 0.625-1.25 mg PO daily PLUS Medroxyprogesterone acetate 10 mg PO for 12 days each month
- 1.1 Adult
- 2 - Pituitary causes
- 2.1 Hyperprolactinemia
- 2.1.1 Drug-induced hyperprolactinemia
- Preferred regimen (1): Micronized 17-β estradiol 1-2 mg PO daily PLUS medroxyprogesterone acetate 2.5-5.0 mg PO daily (continuous)
- Preferred regimen (2): Micronized 17-β estradiol 1-2 mg PO daily PLUS medroxyprogesterone acetate 10 mg PO for 12 days each month (sequential)
- Preferred regimen (3): 17-β estradiol 1-2 mg transdermal daily PLUS micronized progesterone 100 mg PO daily (continuous)
- Preferred regimen (4): 17-β estradiol 1-2 mg transdermal daily PLUS micronized progesterone 200 mg PO for 12 days each month (sequential)
- Alternative regimen (1): Cabergoline 0.25 mg PO twice weekly
- 2.1.2 Prolactinoma
- Preferred regimen (1): Cabergoline 0.25 mg PO twice weekly (can increase to 0.25 mg four times a week up to 1 mg twice weekly)
- Preferred regimen (2): Bromocriptine 1.25-2.5 mg PO daily initially (may increase by 2.5 mg/day every 2-7 days). Up to 30 mg PO daily
- Preferred regimen (3): Alora 0.05, 0.075, and 0.1 mg transdermal daily, applied twice weekly PLUS Medroxyprogesterone acetate 10 mg PO for 12 days each month
- Preferred regimen (4): Climara 0.025, 0.05, 0.075, and 0.1 mg transdermal daily, applied once weekly PLUS Medroxyprogesterone acetate 10 mg PO for 12 days each month
- Preferred regimen (5): Esclim 0.025, 0.0375, 0.05, 0.075, 0.1 mg transdermal daily, applied twice weekly PLUS Medroxyprogesterone acetate 10 mg PO for 12 days each month
- Preferred regimen (6): Vivelle-dot 0.037, 0.05, 0.075, 0.1 mg transdermal daily, applied twice weekly PLUS Medroxyprogesterone acetate 10 mg PO for 12 days each month
- Preferred regimen (7): Premarin 0.625-1.25 mg PO daily PLUS Medroxyprogesterone acetate 10 mg PO for 12 days each month
- 2.1.3 Resistant and malignant prolactinoma
- Preferred regimen (1): Cabergoline 1 mg PO twice weekly
- Preferred regimen (2): Bromocriptine 30 mg PO daily
- Preferred regimen (3): Temozolomide 150–200 mg/m2 IV infusion for five of every 28 days[1]
- 2.1.4 Prolactinoma during pregnancy
- Preferred regimen (1): Bromocriptine 1.25-2.5 mg PO daily initially (may increase by 2.5 mg/day every 2-7 days). Up to 30 mg PO daily
- 2.1.1 Drug-induced hyperprolactinemia
- 2.1 Hyperprolactinemia
- 3 - Ovary insufficiency
- 3.1 Premature ovarian insufficiency[2]
- 3.1.1 Adult
- Preferred regimen (1): Micronized 17-β estradiol 1-2 mg PO daily PLUS medroxyprogesterone acetate 2.5-5.0 mg PO daily (continuous)
- Preferred regimen (2): Micronized 17-β estradiol 1-2 mg PO daily PLUS medroxyprogesterone acetate 10 mg PO for 12 days each month (sequential)
- Preferred regimen (3): 17-β estradiol 1-2 mg transdermal daily PLUS micronized progesterone 100 mg PO daily (continuous)
- Preferred regimen (4): 17-β estradiol 1-2 mg transdermal daily PLUS micronized progesterone 200 mg PO for 12 days each month (sequential)
- Alternative regimen (1): Conjugated equine estrogen 0.625-1.25 mg PO daily PLUS micronized progesterone 100 mg PO daily (continuous)
- Alternative regimen (2): Conjugated equine estrogen 0.625-1.25 mg PO daily PLUS micronized progesterone 200 mg PO for 12 days each month (sequential)
- 3.1.1 Adult
- 3.2 Turner syndrome[3]
- 3.2.1 12-13 years old
- 3.2.2 12.5-15 years old
- Gradually increase 17-β estradiol dose over about 2 years (e.g., 14, 25, 37, 50, 75, 100, 200 μg daily via patch) to adult dose, as following:
- Preferred regimen (1): 17-β estradiol 100–200 μg transdermal daily
- Preferred regimen (2): Micronized estradiol 2–4 mg PO daily
- Preferred regimen (3): Ethinyl estradiol 20 μg PO daily
- Preferred regimen (4): Conjugated equine estrogen 1.25–2.5 mg PO daily
- Gradually increase 17-β estradiol dose over about 2 years (e.g., 14, 25, 37, 50, 75, 100, 200 μg daily via patch) to adult dose, as following:
- 3.2.3 14-16 years old
- Preferred regimen (1): Micronized progesterone 200 mg PO daily on the 20th–30th days of monthly cycle
- Preferred regimen (2): Micronized progesterone 200 mg PO daily on the 100th–120th days of 3-month cycle
- 3.1 Premature ovarian insufficiency[2]
- 4 - Chronic anovulation
- 4.1 Polycystic ovary syndrome (PCOS)
- 4.1.1 Adult
- Preferred regimen (1): Clomiphene citrate 50 mg PO daily for 5 days (starting on day 2–5 following a spontaneous or progestin-induced withdrawal bleeding)[4]
- Preferred regimen (2): Metformin 500 mg PO q8h (lactic acidosis in renal impairment)[5]
- Preferred regimen (3): Follicle stimulating hormone (FSH) 37.5–75 IU SC or IM daily[6]
- Alternative regimen (1): Tamoxifen 20 to 80 mg PO daily during the cycle[7]
- Alternative regimen (2): Sibutramine 10 mg PO daily[8]
- Alternative regimen (3): Orlistat 120 mg PO q8h[9]
- Alternative regimen (4): Troglitazone 300-600 mg PO daily (weight gain)[10]
- Alternative regimen (5): Follicle stimulating hormone (FSH) 150 IU SC or IM daily [cause ovarian hyperstimulation syndrome (OHSS)[11]]
- 4.1.2 Pediatric
- 4.1.1 Adult
- 4.1 Polycystic ovary syndrome (PCOS)
References
- ↑ Ortiz LD, Syro LV, Scheithauer BW, Rotondo F, Uribe H, Fadul CE; et al. (2012). "Temozolomide in aggressive pituitary adenomas and carcinomas". Clinics (Sao Paulo). 67 Suppl 1: 119–23. PMC 3328813. PMID 22584716.
- ↑ "Committee Opinion No. 698: Hormone Therapy in Primary Ovarian Insufficiency". Obstet Gynecol. 129 (5): e134–e141. 2017. doi:10.1097/AOG.0000000000002044. PMID 28426619.
- ↑ Bondy, Carolyn A. (2007). "Care of Girls and Women with Turner Syndrome: A Guideline of the Turner Syndrome Study Group". The Journal of Clinical Endocrinology & Metabolism. 92 (1): 10–25. doi:10.1210/jc.2006-1374. ISSN 0021-972X.
- ↑ Dickey RP, Taylor SN, Curole DN, Rye PH, Pyrzak R (1996). "Incidence of spontaneous abortion in clomiphene pregnancies". Hum. Reprod. 11 (12): 2623–8. PMID 9021363.
- ↑ Harborne L, Fleming R, Lyall H, Norman J, Sattar N (2003). "Descriptive review of the evidence for the use of metformin in polycystic ovary syndrome". Lancet. 361 (9372): 1894–901. doi:10.1016/S0140-6736(03)13493-9. PMID 12788588.
- ↑ Balasch J, Fábregues F, Creus M, Casamitjana R, Puerto B, Vanrell JA (2000). "Recombinant human follicle-stimulating hormone for ovulation induction in polycystic ovary syndrome: a prospective, randomized trial of two starting doses in a chronic low-dose step-up protocol". J. Assist. Reprod. Genet. 17 (10): 561–5. PMC 3455454. PMID 11209536.
- ↑ Steiner AZ, Terplan M, Paulson RJ (2005). "Comparison of tamoxifen and clomiphene citrate for ovulation induction: a meta-analysis". Hum. Reprod. 20 (6): 1511–5. doi:10.1093/humrep/deh840. PMID 15845599.
- ↑ Sabuncu T, Harma M, Harma M, Nazligul Y, Kilic F (2003). "Sibutramine has a positive effect on clinical and metabolic parameters in obese patients with polycystic ovary syndrome". Fertil. Steril. 80 (5): 1199–204. PMID 14607575.
- ↑ Jayagopal V, Kilpatrick ES, Holding S, Jennings PE, Atkin SL (2005). "Orlistat is as beneficial as metformin in the treatment of polycystic ovarian syndrome". J. Clin. Endocrinol. Metab. 90 (2): 729–33. doi:10.1210/jc.2004-0176. PMID 15536162.
- ↑ Azziz R, Ehrmann D, Legro RS, Whitcomb RW, Hanley R, Fereshetian AG, O'Keefe M, Ghazzi MN (2001). "Troglitazone improves ovulation and hirsutism in the polycystic ovary syndrome: a multicenter, double blind, placebo-controlled trial". J. Clin. Endocrinol. Metab. 86 (4): 1626–32. doi:10.1210/jcem.86.4.7375. PMID 11297595.
- ↑ Wang CF, Gemzell C (1980). "The use of human gonadotropins for the induction of ovulation in women with polycystic ovarian disease". Fertil. Steril. 33 (5): 479–86. PMID 6768596.
- ↑ Glueck, C.J; Wang, Ping; Fontaine, Robert; Tracy, Trent; Sieve-Smith, Luann (2001). "Metformin to restore normal menses in oligo-amenorrheic teenage girls with polycystic ovary syndrome (PCOS)11The full text of this article is available via JAH Online at http://www.elsevier.com/locate/jahonline". Journal of Adolescent Health. 29 (3): 160–169. doi:10.1016/S1054-139X(01)00202-6. ISSN 1054-139X. External link in
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