LH-RH therapy in functional amenorrhea based on clinical subclassification

The diagnostic approach to functional amenorrhea comprising a gestagen test, an LH-RH test, and the response to clomiphene as well as the recording of endogenous LH episodes allows a subclassification of the patients with regard to different therapeutic approaches. According to the degree of endogenous LH-RH deficiency, which is reflected by this diagnostic workup, a therapy with clomiphene alone, LH-RH combined with clomiphene, or LH-RH alone is effective. To avoid paradoxical effects any LH-RH substitution has to meet physiological conditions. Thus pulsatile and low-dose LH-RH administration of varied duration proved able to prime the hypothalamo-pituitary unit for either clomiphene or gonadal feedback signals resulting in ovulation and corpus luteum formation.