LH/FSH ratio: a better marker of secondary amenorrhea in patients from eastern Nepal

FSH, LH and prolactin (PRL) levels were assessed by ELISA in 50 cases with secondary amenorrhea and 52 age and sex-matched healthy controls from eastern Nepal. Cases were diagnosed by differential diagnosis, and data were analyzed using standard statistical tools. Early stage (3-6 months) and long standing (> 6 months) secondary amenorrhea had no effect (p > 0.05) in hormonal parameters studied. Pulse, SBP, DBP, weight, height, age of menarche, cycle interval and duration of flows were homogenous (p > 0.05) in patients and controls. Median age of menarche, median cycle interval and median duration of flows in healthy subjects were 14 years, 30 and 4 days respectively. FSH in cases (15.38 +/- 7.24 mU/ml) was significantly elevated (p < 0.01) as compared to controls (9.38 +/- 6.34 mU/ml). LH in cases (35.44 +/- 24.35 mU/ml, median 36.5 mU/ml) was significantly (p < 0.01) elevated by almost 5 times of its mean value and 9 times of its median value as compared to that of controls (7.58 +/- 6.604 mU/ml, median 4.2 mU/ml). LH/ FSH ratio in cases (2.44 +/- 1.73, median 2.00) was significantly higher (p < 0.01) as compared to controls (0.82 +/- 0.42, median 0.76). FSH e"12 mU/ml, LH e"10 mU/ml and LH/FSH ratio e"1 cut offs were significantly associated (p = 0.000 in each) with the cases as revealed by chi-square analysis, and LH/FSH ratio e"1 (Sensitivity = 84.0%, specificity = 77.0%) was found to be a stronger marker of secondary amenorrhea. As the elevation of LH was more pronounced than that of FSH, this study hints towards possible LH receptor mutation, which is generally found in premature ovarian failure (POF). Diagnosis of cases in this region may need a new cut off level for POF, as the elevation of FSH itself was not as pronounced as reported by other workers.