Ovulation disorders: part I anovulation associated with estrogen deficiency

To describe the diagnosis and treatment of anovulatory disorders associated with estrogen deficiency.

Anovulation with estrogen deficiency was divided into two types: association with low vs. high serum gonadotropin levels. Treatments included bromocriptine or cabergoline for hyperprolactinemia and gonadotropins for normal prolactin levels. When gonadotropins were low, lowering the elevated serum FSH to restore down-regulated FSH receptors in the few remaining follicles with either ethinyl estradiol or GnRH agonists or antagonists was used. High serum FSH was followed by either close observation for spontaneous follicular maturation or low dose gonadotropin stimulation. Progesterone supplementation, especially by vaginal use, was given in the luteal phase.

Though success in ovulation induction and pregnancies was greater in women with low FSH than high FSH, pregnancies following ovulation induction were nevertheless achieved even in women in apparent menopause.

The use of ethinyl estradiol as opposed to other estrogen drugs has the advantage of not being able to be measured by most serum assays for estradiol allowing the physician to detect endogenous follicular development and thus determining when follicular maturation has been achieved. Even in the presence of marked diminished ovarian egg reserve, eggs from chronically younger women are superior in quality to women aged > or = 45.