Diagnosis and management of post-pill amenorrhea

Post-pill amenorrhea is, in most cases, a relatively uncomplicated medical problem to diagnose and treat, but it is imperative to exclude pituitary tumors or serious endocrinological abnormalities before treatment is begun. Subjectively, post-pill amenorrhea is the failure to resume menstruation within six months after discontinuation of oral contraceptives. Objectively, a pattern of hypothalamic deficiency may be found, which usually consists of low values for the gonadotropic and ovarian hormones and mild to moderate elevations of prolactin. Treatment is required only if pregnancy is desired. Two very effective drugs are available that can be safely administered by the interested family physician: bromocriptine and clomiphene. Women not desiring pregnancy at the time can be managed with reassurance in the expectation of a spontaneous return of menstruation and with periodic follow-ups that may include progesterone withdrawal testing.