Treatment of hyperprolactinemic amenorrhea with pulsatile gonadotropin-releasing hormone therapy

Pulsatile GnRH therapy has been shown effective in the treatment of infertility associated with hyperprolactinemia by direct action on the pituitary. Gonadotropin secretion was restored in the setting of moderate hyperprolactinemia. GnRH should be considered as a potential alternative to BCPT therapy in this setting.     

Treatment of hyperprolactinemic amenorrhea by intermittent administration of bromocryptine (CB 154)

The results obtained with intermittent bromocryptine treatment from the fifth day after the beginning of menstruation until the second day after the basal temperature rise, in 14 women with hyperprolactinemic amenorrhea-galactorrhea and in whom menses had previously been induced by continuous treatment, are presented. All women had menses without reappearance of galactorrhea; serum FSH, LH, estradiol, and progesterone followed a normal physiologic trend. Only prolactin rose again in the second phase of the cycle, in which lower levels of progesterone were also found, but without any significant interference in the clinical and hormonal trend. It is stressed that administration of bromocryptine during the first part of the cycle might substitute for continuous administration, thereby reducing drug consumption and hence possible side-effects as well as the cost of treatment.     

Primary hyperprolactinemic amenorrhea. Report of 4 patients

Report about 4 female patients with hyperprolactinemic primary amenorrhea. In two of these women there was a suspicion of adenoma of hypophysis. In the stimulation test with gonadotropin-releasing hormone and thyrotropin-releasing hormone in two females the very high basal PRL secretion could not have been stimulated in one case. In the other case the TRH-stimulated PRL serum levels increased. Biphasic menstrual cycles resulted by therapy in two females treated with bromoergocryptine.     

Treatment of hyperprolactinemic conditions with bromoergocryptine

Ten hyperprolactinemic patients were treated by a daily dose of 5 mg bromergocryptine (Parlodel, Sandoz). The prolactine concentration in the peripherial blood showed a fast declind and after two months the patients were relieved from the symptoms (galactorrhea, amenorrhea). As side-effects of the compound headache and nausea were noted.     

Metergoline in the management of normoprolactinemic secondary amenorrhea. A multicentric controlled trial

In a multicentric study, the effect of the antiserotoninergic agent metergoline was evaluated in the management of patients with idiopathic normoprolactinemic secondary amenorrhea (NSA). The awareness that psychological factors might lead to a spontaneous reappearance of menses was also taken into account, and all the patients, after physical, gynecological and laboratory examinations, and the performance of the progesterone withdrawal bleeding test (100 mg i.m.) and the clomiphene citrate test (100 mg p.o./day for 5 days), were treated for 60 days with placebo; only patients showing no menses during placebo administration were later treated with metergoline. 108 patients entered the trial: of these, 48 experienced menses on admission or during placebo administration, and were withdrawn. Of the 60 patients not responding to placebo, 50 were treated for 90 days with metergoline (4 mg t.i.d.), and 23 had menses, ovulatory in 68.4% of cases. A new placebo treatment was accompanied, in the majority of cases, by recurrence of amenorrhea. These results indicate that many patients with NSA may experience a spontaneous disappearance of the disease: in cases more seriously affected metergoline might be a useful therapeutic agent.     

Treatment of hyperprolactinemic luteal insufficiency with bromocriptine

Twelve patients with infertility and insufficent luteal function were studied during a control cycle, and during a cycle when 2.5 mg of bromocriptine was given twice daily. Serum levels of prolactin, progesterone, estradiol-17-beta, FSH and LH were determined during both cycles. Endometrial biopsies were taken from most patients during the late luteal phase. Two patients had persistent hyperprolactinemia, approximately 35-45 ng/ml, and both had repeated insufficient luteal function, which completely reverted to normal during treatment. Five of the 10 normoprolactinemic patients achieved a normal luteal function during bromocriptine therapy. No pregnancies were achieved during the study but one patient later conceived during bromocriptine therapy.     

Induction of ovulation in women with hyperprolactinemic amenorrhea using clomiphene and human chorionic gonadotropin of bromocriptine.

Clomiphene citrate (Clomid), when given alone, is generally considered ineffective in inducing ovulation in women with hyperprolactinemia. This study reports the treatment of 29 infertile women with hyperprolactinemic amenorrhea. Twenty-one patients (eighteen of whom had previously had no ovulation response to Clomid alone) were treated with a combined regimen of Clomid (100 to 200 mg/day for 5 days) and two injections of 5000 IU of human chorionic gonadotropin (HCG), the first 8 to 10 days after Clomid withdrawal and a second injection 1 week later. Basal body temperature charts, conception, and/or plasma progesterone measurements showed that 19 patients ovulated (90%). There were 17 pregnancies in 12 of 21 patients (57% pregnancy rate) with 15 single live births and two abortions. When bromocriptine (Parlodel) became available, a total of 22 patients (including 14 patients previously treated with Clomid/HCG, six of them successfully) with amenorrhea associated with hyperprolactinemia were treated with this drug with dosages varying from 2.5 mg to 15 mg/day. Ovulation was confirmed in 20 patients (90%). There were 17 pregnancies in 15 patients (68% pregnancy rate) with 15 single live births and two first-trimester abortions. In all, 21 of 29 patients (73%) achieved one or more pregnancies resulting in live births with one or both of the above treatments. It is concluded that a combined Clomid/HCG regimen can often be used as an effective alternative to bromocriptine therapy in the treatment of infertility associated with hyperprolactinemic amenorrhea.     

Bromocriptine in hyperprolactinemic amenorrhea: a possible early effect on ovarian steroidogenesis.

The effect of bromocriptine was studied in a 28-year-old cretin woman who presented with long-term untreated primary hypothyroidism, primary amenorrhea, hyperprolactinemia, and an enlarged pituitary fossa. Bromocriptine therapy lowered the plasma prolactin and caused an early rise in plasma 17 beta-estradiol levels and uterine bleeding, despite the failure of plasma gonadotrophins to respond to luteinizing hormone release hormone (LHRH) administration. Thus, it is suggested that bromocriptine may have an early direct effect on the ovary in hyperprolactinemic amenorrhea.     

Treatment of functional hypothalamic amenorrhea with hypnotherapy

OBJECTIVE: To determine the effects of hypnotherapy on resumption of menstruation in patients with functional hypothalamic amenorrhea (FHA). DESIGN: Uncontrolled clinical study. SETTING: Academic clinical care center. PATIENT(S): Twelve consecutive women with FHA were selected. INTERVENTION(S): A single 45- to 70-minute session of hypnotherapy was administered, and patients were observed for 12 weeks. MAIN OUTCOME MEASURE(S): Patients were asked whether or not menstruation resumed and whether or not well-being and self-confidence changed. RESULT(S): Within 12 weeks, 9 out of 12 patients (75%) resumed menstruation. All of the patients, including those who did not menstruate, reported several beneficial side effects such as increased general well-being and increased self-confidence. CONCLUSION(S): Hypnotherapy could be an efficacious and time-saving treatment option that also avoids the pitfalls of pharmacological modalities for women with FHA.     

Treatment of post-pill amenorrhea

Post-pill amenorrhea, a relatively rare but important sequela of oral contraceptive use, is often accompanied by galactorrhea. A review of women with post-pill amenorrhea-galactorrhea (PPAG) showed that it has more than one cause. Clinical and laboratory methods of evaluation are reviewed, and appropriate methods of treatment are suggested.     

闭经的中医治疗方略

闭经的病因涉及范围广而复杂,主要与下丘脑-垂体-卵巢轴的功能失常有关,社会环境因素的改变,食品污染的出现,社会竞争、工作压力的不断加剧,以及避孕节育措施使用不当,均可引起生殖内分泌调节轴的功能失常,致使闭经的发生率明显上升[1]。对于闭经,中医药治疗有一定的优势和特色     

Metergoline as an inhibitor of prolactin release

In a randomized, double-blind study, 12 and 16 mg of metergoline and 5 mg of bromoergocriptine were given daily to three groups of 100 women each for ten consecutive days to prevent lactation. Excellent or good results were obtained in 86%, 90% and 83%, respectively. Serum prolactin (PRL) levels were evaluated in three settings. The first was after a single dose in four groups of patients (4, 6 and 8 mg of metergoline and 2.5 mg of bromoergocriptine were studied for ten hours). Second, for a study of the suckling reflex, PRL levels were measured 15, 30 and 60 minutes after breast stimulation in four groups of five patients each: two groups on the fourth postpartum day with and without metergoline treatment and two groups on the eighth postpartum day (the reflex was suppressed in the two groups treated with metergoline). Third, serum PRL levels rose after the intravenous administration of 200 mg of thyrotropin-releasing hormone (TRH) in another two groups of ten patients, one treated with metergoline and the other not so treated. TRH stimulation was not blocked in the treated groups.     

Treatment with hachimijiogan, a non-ergot Chinese herbal medicine, in two hyperprolactinemic infertile women

Two hyperprolactinemic infertile women, one with and one without a pituitary adenoma, who were resistant to bromocriptine treatment, were treated orally with Hachimijiogan, a Chinese herbal medicine. This treatment reduced the serum prolactin level, resulting in a normal ovulatory cycle and pregnancy, without side effects.