[Amenorrhoea following oral contraception. Pathophysiological problems (author's transl)]

Area of Science:

• Reproductive Endocrinology
• Neuroendocrinology

Background:

• Anovulatory steroids and oral contraceptives can mask hypothalamic-pituitary-ovarian axis disorders.
• Post-contraceptive amenorrhoea may suggest prior anterior pituitary dysfunction, specifically altered feedback mechanisms.

Purpose of the Study:

• To elucidate the mechanisms of post-contraceptive amenorrhoea.
• To investigate the role of the hypothalamus-pituitary-ovarian axis and feedback mechanisms in menstrual cycle disorders.

Main Methods:

• Analysis of menstrual cycle recovery after discontinuation of anovulatory steroids.
• Evaluation of gonadotropic axis function, including feedback mechanisms and prolactin secretion.
• Assessment of amenorrhoea etiology, including potential pituitary microadenoma.

Main Results:

• Hypothalamus-pituitary-ovarian function typically normalizes within one month post-anovulatory steroid cessation.
• Follicular phase prolongation and ovulation restoration occur within 3-4 weeks.
• Post-contraceptive amenorrhoea can indicate impaired oestradiol feedback and excessive negative feedback on the gonadotropic axis.
• Galactorrhoea may accompany amenorrhoea, potentially linked to prolactin secretion influenced by oestrogens and progestogens.

Conclusions:

• Oral contraception itself does not cause amenorrhoea but can mask underlying gonadotropic axis dysfunction.
• Amenorrhoea, particularly post-contraceptive, warrants thorough etiological investigation of the anterior pituitary and feedback mechanisms.
• Pituitary microadenoma should be considered with elevated prolactin levels; oestrogenic treatments should be halted.