Metergoline in the management of normoprolactinemic secondary amenorrhea. A multicentric controlled trial

In a multicentric study, the effect of the antiserotoninergic agent metergoline was evaluated in the management of patients with idiopathic normoprolactinemic secondary amenorrhea (NSA). The awareness that psychological factors might lead to a spontaneous reappearance of menses was also taken into account, and all the patients, after physical, gynecological and laboratory examinations, and the performance of the progesterone withdrawal bleeding test (100 mg i.m.) and the clomiphene citrate test (100 mg p.o./day for 5 days), were treated for 60 days with placebo; only patients showing no menses during placebo administration were later treated with metergoline. 108 patients entered the trial: of these, 48 experienced menses on admission or during placebo administration, and were withdrawn. Of the 60 patients not responding to placebo, 50 were treated for 90 days with metergoline (4 mg t.i.d.), and 23 had menses, ovulatory in 68.4% of cases. A new placebo treatment was accompanied, in the majority of cases, by recurrence of amenorrhea. These results indicate that many patients with NSA may experience a spontaneous disappearance of the disease: in cases more seriously affected metergoline might be a useful therapeutic agent.