Eleven patients with hypothalamic primary amenorrhoea, aged between 17 and 23 years, were examined. Each patient was given 10 mg
epimestrol (E) orally over a period of 10 days followed by a 20-day pause. This regimen was repeated 6 times.
Gonadotropin secretory patterns were investigated between 9 a.m. and 2 p.m. before, during (on the 5th day of treatment in the 4th cycle) and 3 weeks after termination of treatment. In addition
LHRH double stimulation tests were carried out before and
after treatment to evaluate the acute releasable pool of
gonadotropins as well as the pituitary synthesis capacity. In 3 patients with low baseline
gonadotropin levels no effect of E on the release of
gonadotropins could be found. These patients also showed non-pulsatile secretion with low baseline
gonadotropin levels and no response in the
LHRH stimulation tests. Similar results could be observed in one patient with low baseline LH levels but FSH levels within the normal range. Variable results were found in 7 patients with both LH and FSH in the normal range: 3 women experienced menstrual
bleeding during and/or after E treatment; 1 woman stated that
spotting had occurred twice. These 4 patients all showed regular pulsatile LH secretion after cessation of E treatment; the duration of the LH pulses was 60 to 120 minutes. Some hypothalamic activity seems to be essential for a positive response to E in patients with primary amenorrhoea. This activity is characterized by a positive
gestagen test as well as baseline
gonadotropin levels in the normal range.(ABSTRACT TRUNCATED AT 250 WORDS)