Classification of secondary amenorrhea based on distinct hormonal patterns

Abstract

Patients with secondary amenorrhea have been classified into 4 clincal groups. In order to further investigate these 4 groups, LH, FSH, and estradiol (E2) were measured at 15 min intervals for 4 h in 21 patients with secondary amenorrhea. Patients within each group had similar hormonal patterns, but there was a distinct variation among the groups. Three patients in group 1 (polycystic ovaries [PCO]) had elevated basal levels of only LH with marked irregular fluctuations. Seven patients in group II (hypothalamic-pituitary dysfunction) had normal basal levels of LH, FSH, and E2. Only LH showed oscillations of varying mahnitude and frequency. Eight patients in group III (hypothalamic-pituitary failure) had low or low-normal levels of LH, FSH, and low E2 with minimal or absent fluctuations. Three patients in group IV (ovarian failure) had high basal levels of FSH and LH and irregular fluctuations. This study confirmed the rationality of separating patients with secondary amenorrhea into 4 different groups. In addition, it was found that in group III patients, the total amount of LH secreted in a 4-hour period of time appears to be insufficient to stimulate E2 production from the ovary even when a single sample was found to be in the normal range.

PIP: Patients with secondary amenorrhea were classified into 4 groups based on clinical evidence. The patients were classified according to the presence of polycystic ovaries (Group 1), hypothalamic-pituitary dysfunction (Group 2), hypothalamic-pituitary failure (Group 3), and ovarian failure (group 4). These groups were further characterized by measurement of luteinizing hormone (LH), follicle stimulating hormone (FSH), and estradiol (E2) every 15 minutes for 4 hours. 3 patients in Group 1 showed elevated basal levels of LH with inconsistent fluctuations. Normal basal levels of LH, FSH, and E2 were observed in 7 patients in Group 2, though there were oscillations in LH levels of varying magnitude and frequency. Low or low-normal levels of LH, FSH and E2, with minimal or no fluctuations, were found in 8 patients in Group 3. In this group, the total amount of LH secreted over the 4-hour period was insufficient to stimulate E2 production from the ovary. 3 patient in Group 4 showed high basal levels of FSH and LH, with irregular fluctuations. The results support the approach of classifying patients with secondary amenorrhea in 4 groups.