Persistent amenorrhea and galactorrhea.

This discussion of persistent amenorrhea and galactorrhea is based on a review of the English literature comprising 47 studies (1485 cases) of persistent postpill amenorrhea completed in 1978 and on the authors experience with 35 fully evaluated patients who had postpill amenorrhea galactorrhea. The incidence of amenorrhea after discontinuation of oral contraceptives (OCs) as observed in uncontrolled prospective studies is 2.0-7.3% at 3 months 0.4-2.4% at 6 months and 1.6% at 12 months. The incidence of spontaneous secondary amenorrhea in all women of reproductive age is 1.8-3.4% at 3 months 0.5-1.4% at 6 months and 0.26% at 12 months. In 1 controlled prospective study so far performed in which specific time periods were observed the incidence of postpill amenorrhea was 2.9% at 3 months whereas the incidence of spontaneously occurring secondary amenorrhea of 3 months duration was 1.8%. The average incidence of postpill galactorrhea in association with amenorrhea is 20.1% The average incidence of galactorrhea in spontaneously occurring secondary amenorrhea is 21.6%. The incidence of pituitary tumor when both amenorrhea and galactorrhea occurred after OC use averaged 23.9% in 5 studies and was 1.2% when only amenorrhea was persistent. The rate of spontaneous recovery of menses is high when persistent amenorrhea follows discontinuation of OCs. A prior history of irregular menses is more frequently obtained from patients with spontaneous secondary amenorrhea than from those with persistent amenorrhea following discontinuation of OCs although the difference between the 2 groups is so small as to be negligible. OCs are often recommended for suppression of excessive ovarian activity in patients with polycystic ovarian disease. No relationship between postpill amenorrhea or postpill amenorrhea-galactorrhea and the use of any particular pill or pill component or dosage can be found. Few of the patients in reported series of postpill amenorrhea have had the benefit of complete evaluation. The return of fertility after discontinuation of OCs is high and is ultimately equal to that following discontinuation of nonhormonal methods of contraception. Treatment with bromocriptine in patients with hyperprolactinemia resulted in 88.6% restoration of ovulatory cycles in cases reported before 1978. The findings suggest that the relationship between OCs and persistent amenorrhea-galactorrhea after discontinuation of OCs is coincidental rather than causal.