Induction of ovulation with low-dose estrogen-progestin therapy in amenorrheic patients

Sixteen amenorrheic patients, five with ovarian and 11 with hypothalamic failure, were treated for three cycles with a biphasic low-dose estrogen-progestin regimen consisting for esterified estrogen, 1.5 mg/day for 21 days, combined for the last 7 days with norethisterone acetate, 5 mg/day. Serum FSH and LH decreased significantly (P less than 0.01) during treatment in the ovarian failure group, and FSH in the hypothalamic failure group. Estradiol levels increased on average two-fold during treatment and decreased again after treatment, these changes being slower in the hypothalamic than in the ovarian failure group. Withdrawal bleeding occurred in all patients during the treatment cycles. After treatment, six patients with hypothalamic failure had spontaneous menstrual bleedings. Judged by serum progesterone measurements, one ovulation occurred in each group during the treatment cycles, and in the hypothalamic failure group, two ovulations were observed 3 wk after treatment. Four women with secondary amenorrhea are presented, in whom conception occurred during biphasic estrogen-progestin treatment; three of these cases had hypergonadotrophic ovarian failure. Our results suggest that low-dose estrogen-progestin treatment may induce ovulation in selected cases of hypothalamic and also of ovarian failure.