Ethinyl estradiol in the treatment of metrorrhagia

Abstract

Irregular bleeding, acyclic bleeding from the uterus, must first be classified according to etiology. Approximately one-half of the patients seen in private practice with this complaint have an organic basis for that bleeding. The other half bleed from the uterus as a result of abnormal physiology in the pituitary-ovarian endometrium cycle. This latter group must be further classified into two groups. Those who bleed from a secretory phase endometrium are essentially normal endocrinologically in that the prime prerequisite for normalcy is present, namely, the maturation of the follicle with the extrusion of the ovum and development of the corpus luteum, followed by normal endometrial response. The patients in whom the bleeding comes from a proliferative phase endometrium are candidates for treatment by endocrine therapy.Bleeding can be controlled satisfactorily by the administration of large oral doses of the estrogens. Use of estrogen-progesterone over a period of three successive months will establish regular cyclic bleeding in about 90 per cent of anovulatory metrorrhagic patients while under treatment. Normal cyclic menstruation will continue in about 70 per cent of patients after discontinuing treatment. Of this latter group, about one-half of them will subsequently menstruate from a secretory phase endometrium, suggesting that the treatment not only controls the immediate bleeding, but may also establish normal, pituitary-ovarian-endometrial physiology. In that group which ovulates following treatment, it is obviously impossible to state that the ovulation was induced by therapy, since spontaneous recovery of ovarian function can occur in the absence of any treatment. However, the relatively high salvage in this group of cases of marked ovarian failure suggests the probability of a cause and effect relationship.