Clinical categorization of patients with secondary amenorrhea using progesterone-induced uterine bleeding and measurement of serum gonadotropin levels

Abstract

A group of ninety unselected women with secondary amenorrhea of at least six months' duration were studied retrospectively. By the use of intramuscular progesterone in oil, it was possible to categorize these patients according to their positive or negative uterine bleeding response. LH, FSH, and estradiol values in the 63 patients of the positive category had a log-normal distribution. LH values were found to be composed of two different populations; FSH and estradiol values were composed of only one population. Based on these LH determinations the entire positive category was then divided into two groups. Patients with high levels of LH (Group I) were clinically diagnosed to have polycystic ovarian disease. Patients with normal levels of LH (Group II) were diagnosed to have hypothalamic-pituitary dysfunction. The 27 patients who failed to have withdrawal uterine bleeding were placed in the negative category. These patients also were shown to have a log-normal distribution for LH, FSH, and estradiol. In contrast to the patients in the positive category, FSH values in these patients were made up of two different populations whereas LH and estradiol values showed only one population. Based on the FSH values these patients were divided into two groups, one with low and normal levels of FSH (Group III) and the second population with high levels of FSH designated as Group IV. Group III represented those patients with hypothalamic-pituitary failure and patients in Group IV were those with ovarian failure. Serial determinations of LH, FSH, and estradiol done prospectively on five consecutive days in 19 of the 90 patients did not give any further information in differentiating among the four groups.