New opportunities of clomiphene citrate treatment for functional hypothalamic amenorrhea
- Authors: Chernukha G.E.1, Gusev D.V.1, Tabeeva G.I.1, Marchenko L.A.1
-
Affiliations:
- National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov Ministry of Health of Russia
- Issue: No 3 (2019)
- Pages: 84-90
- Section: Articles
- URL: https://journals.eco-vector.com/0300-9092/article/view/248442
- DOI: https://doi.org/10.18565/aig.2019.3.84-90
- ID: 248442
Cite item
Open Access
Access granted
Abstract
Objective. To evaluate the efficiency of clomiphene citrate (CC) therapy for functional hypothalamic amenorrhea (FHA). Subjects and methods. A total of 84 patients with FHA underwent clinical and laboratory examinations. The patients received down-step therapy with CC, by reducing its cycle dose and use duration. The response to CC was rated as complete, partial, or absent in terms of the presence of menses and their preservation after therapy discontinuation. Results. Menses were observed to appear in 76.2% of the patients during the therapy; these preserved in 23.8% after its discontinuation. The predictors of response to therapy as recovery of the intrinsic rhythm of menstruation included LH levels > 2.71 IU/l, estradiol > 106.5 nmol/l, LH/FSH > 0.88, and BMI > 20.6 kg/m2. Conclusion. Down-step CС therapy may contribute to sensitization of the hypothalamic-pituitary-ovarian axis, to the appearance of menstruations in 76.2% of the patients, and to their subsequent preservation in every three of them.
Full Text
About the authors
Galina E. Chernukha
National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov Ministry of Health of Russia
Email: c-galina1@yandex.ru
MD, professor
Dmitry V. Gusev
National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov Ministry of Health of Russia
Email: doctor.dgusev@gmail.com
postgraduate student
Guzyal I. Tabeeva
National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov Ministry of Health of Russia
Email: doctor.gtab@gmail.com
PhD, senior researcher
Larisa A. Marchenko
National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov Ministry of Health of Russia
Email: l_marchenko@yandex.ru
MD, professor
References
- Gordon C.M., Ackerman K.E., Berga S.L., Kaplan J.R., Mastorakos G., Misra M. et al. Functional hypothalamic amenorrhea: An Endocrine Society Clinical Practice Guideline. J. Clin. Endocrinol. Metab. 2017; 102(5): 1413-9.
- Falsetti L., Gambera A., Barbetti L., Specchia C. Long-term follow-up of functional hypothalamic amenorrhea and prognostic factors. J. Clin. Endocrinol. Metab. 2002; 87(2): 500-5.
- Brown J., Farquhar C. Clomiphene and other antioestrogens for ovulation induction in polycystic ovarian syndrome. Cochrane Database Syst. Rev. 2016; (12): CD002249.
- Rowe T.C., Pride S.M. The action of clomiphene in stress-induced amenorrhea. Am. J. Obstet. Gynecol. 1984; 148(5): 613-6.
- Armeanu M.C., Moss R.J., Schoemaker J. Ovulation induction with a single-blind treatment regimen comparing naltrexone, placebo and clomiphene citrate in women with secondary amenorrhea. Acta Endocrinol. (Copenh.). 1992; 126(5): 410-5.
- De Leo V, la Marca A., Lanzetta D., Morgante G. Administration of L-thyroxine does not improve the response of the hypothalamo-pituitary-ovarian axis to clomiphene citrate in functional hypothalamic amenorrhea. Eur. J. Obstet. Gynecol. Reprod. Biol. 2000; 90(1): 103-8.
- Djurovic M., Pekic S., Petakov M., Damjanovic S., Doknic M., Dieguez C. et al. Gonadotropin response to clomiphene and plasma leptin levels in weight recovered but amenorrhoeic patients with anorexia nervosa. J. Endocrinol. Invest. 2004; 27(6): 523-7.
- Borges L.E., Morgante G., Musacchio M.C., Petraglia F., De Leo V New protocol of clomiphene citrate treatment in women with hypothalamic amenorrhea. Gynecol. Endocrinol. 2007; 23(6): 343-6.
- Legro R.S., Brzyski R.G., Diamond M.P., Coutifaris C., Schlaff W.D., Casson P. et al. Letrozole versus clomiphene for infertility in the polycystic ovary syndrome. N. Engl. J. Med. 2014; 371(2): 119-29.
- Corenblum B., Taylor P.J. Utilization of the biochemical response to clomiphene citrate for the selection of women with hypothalamic amenorrhea who require further investigation. Fertil. Steril. 1987; 48(5): 766-9.
- Altinkaya S.O., Talas B.B., Gungor T., Gelerman C. Treatment od clomiphene-citrate-related ovarian cyst in a prospective randomized study. A single center experience. J. Obstet. Gynaecol. Res. 2009; 35(5): 940-5.
Supplementary files
