[The influence of endogenous opioids in hypothalamic amenorrhea. Diagnostic and therapeutic aspects]

We investigated the possibility of induction of ovulation by means of chronic opioid receptor blockade with naloxone. Daily 4 mg were given as an intravenous bolus injection in 4 women suffering from hypothalamic amenorrhea till the 30th day of therapy. A possible maturation of ovarian follicles and a subsequent ovulation should be proved by means of daily determination of LH, FSH, estradiol and progesterone as well as of a sonographic folliculometry. The day prior to and the first day of naloxone treatment we took blood samples every 10 minutes during 4 hours for determination of LH pulse frequency and amplitude. Neither we found any alteration of the basal values of LH, FSH and estradiol, nor we observed a follicular growth. These results lead us to the conclusion to introduce a naloxone stimulation test as a further diagnostic step. In this way opioid mediated hypothalamic ovarian insufficiencies could be registered and a sufficient therapy could be reached.