First ; to gain an overview of the causes of amenorrhea and to acquire proper perspectives of the menstrual disorders resulting from inappropriate feedback systems, a classification of amenorrhea is necessary. Second; it is clinically convenient
to
classify the etiologies of amenorrhea on the basis of presence or absence of progestin-induced withdrawal bleeding(WB) distinguishing between dysfunction within the hypothalamo-pituitary(H-P) axis. Third ; the traditional concept of standard
treatment
in amenorrheic patients with progestin-induced WB has been to utilize clomiphene citrate to induce ovulation and a positive ovulatory response with this drug would serve as diagnostic proof of hypothalamic dysfunction, as well as a therapeutic
means of
correcting anovulation.
With these rationales, we studied 73 women with amenorrhea to find the common causes and to reevaluate the value of functional classification by clomiphene citrate stimulation test(CCST) in the aspect of standard treatment from June, 1994 to
April,
1996. 11 patients had primary amenorrhea and 62 patients had secondary amenorrhea. The common causes of amenorrhea are polycystic ovarian syndrome, hyperprolactinemia, premature ovarian failure, and uterine synechia. The positive response rate of
CCST
was 18% in H-P failure group(I) and 69% in H-P dysfunction group(IIa) except polycystic ovarian syndromes (p<0.05). The basal serum level of LH was different(p<0.05), but E2 level was not different (p=0.07) between two groups.
The present study supports that the functional classification of amenorrhea is clinically valuable and that there is no absolute serum E2 level will discriminate between those who have progestin-induced WB and those who do not.
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