The amenorrhea-galactorrhea syndrome following oral contraceptives.

Endocrinological tests were performed on 4 women ages 19 to 36 with amenorrhea-galactorrhea syndrome after oral contraception. The types and durations in months of oral therapy were 1) 2 unspecified combination types and then 1 unspecified sequential type for a total of 36 months 2) ethynodiol diacetate for 30 3) norethindrone for 12 and 4) ethynodiol diacetate for 3. Patient 1 had galactorrhea while still on a pill. Estrogenic activity was low in Patients 1 3 and 4. Urinary gonadotropins were within normal limits by bioassay criteria but the results of this type of bioassay are suspect. Urinary 17-ketosteroids and 17-hydroxysteroids were normal. Normal basal levels were yielded with growth hormone studies. To assess pituitary function visual fields were done and were normal. Patients 2 and 3 responded favorably to clomiphene citrate therapy. Patient 4 responded little. Patient 1 gave no response at all. Since Patients 2 and 4 tended toward oligo-amenorrhea in their menstrual histories the pills seem to have aggravated a state of hypothalamic-pituitary dysfunction. In Patients 1 and 3 a state of dysfunction was created or a borderline state worsened. The duration of medication seems to have little bearing on the syndrome. The syndrome may be present while oral agents are in use. Amenorrhea is observed temporarily with exogenous control of bleeding but with steroid discontinuation the condition may continue by abnormal feedback.