Abstract

PIP: In an effort to determine whether secondary amenorrhea following oral contraception is causal or coincidental, the author reviews data on the incidence of postpill amenorrhea in the general population. In 1 study involving a series of 2702 women, it was demonstrated that secondary amenorrhea occurred in a significant proportion of initially healthy women and that the incidence varied considerably with age. Follow up of women stopping the pill in major clinical trials has shown that the incidence of postpill amenorrhea is very low. Studies have shown that any persistent adverse effect of the pill upon fertility is very rare or very slight. It was reported that women with postpill amenorrhea were particularly likely to present with galactorrhea, but this was found to be incorrect. 1 study noted a higher incidence of galactorrhea in hypogonadotropic secondary amenorrhea (41.5% but not in a small normogonadotropic series (10%). It has been reported that in 41.7% of women with secondary amenonorrhea at a certain clinic, the symptom followed oral contraception. In another report 9.3% of patients with amenorrhea were previous pill users. The authors concludes that there is no good epidemiological evidence to support the commonly held assumption of a causal relationship between oral contraception and postpill amenorrhea in women with a history of regular menstruation. The incidence of postpill amenorrhea in women with previously irregular menstruation is, however, possibly higher than might be expected by chance.