epimestrol and Amenorrhea

There are many methods that can be used to induce ovulation when there is a fault in ovulation in patients who have normal prolactin levels. These are: Bringing the weight to a normal level. Giving Clomiphene. Giving Tamoxifen. Giving cyclofenil and bromocriptine, which really have no more effect than giving a placebo. Giving gonadotrophins in a classical way. This is very useful where there is hypogonadic amenorrhoea but much less useful when the failure of ovulation occurs with normal gonadic function. It is accompanied by a risk of multiple pregnancies and of hyperstimulation, which should be monitored by ultrasound very strictly so that it cannot become too serious. The use of purified FSH which theoretically should be more adequate, at least in cases where the gonadic function is normal in spite of failure of ovulation. Pulsatile administration of LHRH, which in cases of hypothalamic amenorrhoea carries less total risk than giving gonadotrophins. Finally, wedge resection of the ovaries which is reversed for polycystic ovaries that are larger than normal in size, and allied methods. The first choice for hypogonadic hypothalamic amenorrhoea would seem to be the LHRH pump; and for failure of ovulation with normal gonadic function Clomiphene or Tamoxifen. When anti-oestrogens fail to correct these latter cases one can choose according to the case between gonadotrophins, choosing if possible pure FSH, and/or wedge resection. In the last resort in these cases the LHRH pump can be used. The frequent failure of these methods show that perhaps it is possible to create a hypogonadotrophic hypogonadism by giving agonists for a long time or antagonists to LHRH in such a way that a second attempt can be made to induce ovulation using gonadotrophins in better conditions of efficacy and safety.

Topics: Amenorrhea; Anovulation; Clomiphene; Cyclofenil; Epimestrol; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Humans; Hypogonadism; Hypopituitarism; Hypothalamic Diseases; Menotropins; Obesity; Ovary; Ovulation Induction; Tamoxifen; Thinness

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)

Topics: Adolescent; Adult; Amenorrhea; Dehydroepiandrosterone; Epimestrol; Estradiol; Estrenes; Female; Follicle Stimulating Hormone; Humans; Hypothalamic Diseases; Luteinizing Hormone; Prolactin; Testosterone

Topics: Adolescent; Adult; Amenorrhea; Bromocriptine; Clomiphene; Cyclofenil; Epimestrol; Estrogens; Female; Humans; Medroxyprogesterone; Progestins

18 patients, between 18 and 24 years of age, affected by normoprolactinemic secondary amenorrhea and still MAP-negative after three successive Epimestrol cycles underwent five cycles of a combined treatment (Bromocryptin and Epimestrol). Before and after the first cycle of combined treatment, in all patients FSH, LH, E2 and PRL were measured. Progesterone was evaluated three days after the thermic rise. The basal temperature was measured daily. In all the examined patients the combined treatment produced the appearance of the menstrual flow after the third therapeutical cycle. In 13 out of the 18 examined patients ovulation was observed. The hormonal dosage highlighted a clear increase in Gonadotropins and Estradiol levels.

Topics: Adolescent; Adult; Amenorrhea; Bromocriptine; Drug Therapy, Combination; Epimestrol; Estradiol; Estrenes; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Prolactin

The effects of epimestrol (5 mg every 6 hours for 5 days) on basal levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (Prl), estradiol, progesterone, and dehydroepiandrosterone sulfate, and on the response to LH-releasing hormone (LH-RH) and thyrotropin-releasing hormone (TRH) stimulation, were studied in 18 cases of secondary amenorrhea and oligomenorrhea of hypothalamic-pituitary origin, in three cases of anorexia nervosa, in two cases of long-lasting progestin-induced amenorrhea, and in one case of precocious menopause. The results in the first 18 patients indicate that epimestrol treatment induces a significant increase in LH and Prl levels after 24 hours, while the FSH increase becomes significant only after 4 days of therapy. Twelve hours after discontinuation of treatment, all three hormone levels decreased significantly to values similar to the basal levels, while the pituitary response to LH-RH indicated a much more marked LH secretion than before treatment. A second test, performed 36 hours after the last drug administration, again showed a significantly higher LH response than that found under basal conditions. No significant variations were observed in the FSH response to LH-RH, nor in the Prl response to TRH. These data suggest that epimestrol interferes at the level of the centers responsible for Prl and gonadotropin secretion in the manner of a weak estrogen.

Topics: Adolescent; Adult; Amenorrhea; Anorexia Nervosa; Dehydroepiandrosterone; Epimestrol; Estradiol; Estrenes; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Gonadotropins, Pituitary; Humans; Luteinizing Hormone; Menstruation Disturbances; Oligomenorrhea; Progesterone; Prolactin; Thyrotropin-Releasing Hormone

Report on the treatment of 310 anovulatory woment in 1173 treatment cycles with Clomiphen, Cyclofenil and Epimestrol. 63% of the patients had a biphasic basal body temperature record after treatment in 718 cycles. Patients with secondary amenorrhea of the first or the second degree had a satisfactory ovulation rate in 71% of the cases only by treatment with Clomiphen. In women with anovulatory cycles an overall ovulation rate of 75% was observed with all three medications. In 73 patients 78 pregnancies occurred. Of these, 38 pregnancies followed Cyclofenil, 25 pregnancies followed Clomiphen and 15 pregnancies followed Epimestrol corresponding to a 15%, 17% and 13% rate in the treated patients. 22 of these pregnancies ended in incomplete abortion. The side effects of Clomiphen especially visual and cystic ovarian and vasomotor side effects are more pronounced than the side effects of Cyclofenil and Epimestrol. The statistical analysis of the clinical results showed that Clomiphen and Cyclofenil had a higher rate of ovulation in secondary amenorrhea of the first or second degree than Epimestrol.

Topics: Amenorrhea; Anovulation; Body Temperature; Clomiphene; Cresols; Cyclofenil; Epimestrol; Estrenes; Female; Humans; Pregnancy; Vision Disorders

Those hormone-determination methods were reported by the authors which help to make the ovary response visible for the experts during the ovulation induction. They also dealt with the determination of basal temperature measuring, oestrogen, pregnandiol, progesterone, oestradiol-17beta, FSH, LH, epimestrol and clomiphen. After the routine determination of the above mentioned parameter a preprinted sheet was done, where every treated case was illustrated graphically. From these cases some of the typical ones were shown and analyzed. The determination of hormonal releasing curves characteristic of hyperstimulation, and the importance of these most dangerous complication was emphasized.

Topics: Adult; Amenorrhea; Calorimetry; Clomiphene; Epimestrol; Estrogens; Female; Follicle Stimulating Hormone; Humans; Luteinizing Hormone; Ovulation; Ovulation Induction; Pregnanediol; Progesterone

155 patients have been treated with epimestrol during 593 menstrual cycles in a daily dosage of 5, 10 or 2.5 mg from the 1st to the 10th or from the 5th to the 14th day of the cycle. 143 patients with secondary amenorrhoea, anovulatory cycles, ovulatory oligomenorrhoea, corpus luteum insufficiency, and normal cycles received epimestrol after an average period of 2.4 years of involuntary infertility. The pregnancy rate was 21% (n = 30), the spontaneous abortion rate 13% (n = 4). Twelve further patients not seeking pregnancy were treated with epimestrol because of secondary amenorrhoea and (or) anovulatory bleeding. The results were as follows: 1) In eugonadotropic secondary amenorrhoea 8 out of 12 patients ovulated, 5 out of 10 patients wanting children became pregnant. No patient with hypogonadotropism ovulated. 2) Out of 25 patients with anovulatory cycles or bleeding 13 ovulated and 4 became pregnant. 3) 17 out of 68 oligomenorrhoeic patients became pregnant. 4) In 12 out of 24 patients with corpus luteum insufficiency the hyperthermic phase improved and four patients became pregnant. 5) In 12 patients without anomalous cycles these remained unchanged and there were no pregnancies. 6) No side effects could be observed.. 155 women (593 cycles) were treated for sterility with daily doses of 5, 10, or 2.5 mg of epimestrol, from the 1st to the 10th or from the 5th to the 14th day of the cycle. 143 of these patients suffered from secondary amenorrhea, anovulatory cycles, ovulatory oligomenorrhea, corpus luteal insufficiency, and even normal cycles, which resulted in an average of 2.4 years of involuntary sterility. The pregnancy rate was 21% (n = 30) and the rate of spontaneous abortion 13% (n = 4). 12 other women were treated with epimestrol because of secondary amenorrhea or anovulatory bleeding. In those patients with eugonadotropic secondary amenorrhea, 8 of 12 ovulated and 5 of 10 desiring children became pregnant. No patients with hypogonadotropism ovulated. Of 25 patients with anovulatory cycles or bleeding, 13 ovulated and 4 became pregnant. Of those with oligomenorrhea, 17 out of 68 became pregnant. 12 out of 24 patients with corpus luteal insufficiency showed in improvement in the hyperthermic phase and 4 became pregnant. 12 patients with normal cycles showed no change and did not become pregnant. No side effects were experienced.

Topics: Abortion, Spontaneous; Amenorrhea; Anovulation; Berlin; Epimestrol; Estrenes; Female; Humans; Infertility, Female; Oligomenorrhea; Pregnancy; Time Factors

Epimestrol 5 mg. daily for 10 days was administered in 119 treatment cycles to 21 women with normal gonadotropins and 33 ovulations were induced. Of the 21 patients, 7 had secondary amenorrhea, 10 had anovulatory oligomenorrhea and 4 had ovulatory oligomenorrhea. 17 patients desired pregnancies and 6 became pregnant. There was 1 pregnancy among 5 women with secondary amenorrhea. There were 3 pregnancies among 9 patients with anovulatory oligomenorrhea and 2 pregnancies in 3 patients with ovulatory oligomenorrhea. The pregnancy rate was 35%. Side effects were not observed.

Topics: Adult; Amenorrhea; Epimestrol; Estrenes; Female; Humans; Infertility, Female; Infertility, Male; Male; Oligomenorrhea; Ovulation; Pregnancy

Topics: Amenorrhea; Anovulation; Epimestrol; Estrenes; Female; Humans; Ovulation; Pregnancy