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THE PRACTICAL VALUE OF THE PROGESTOGEN CHALLENGE TEST, SERUM OESTRADIOL ESTIMATION OR CLINICAL EXAMINATION IN ASSESSMENT OF THE OESTROGEN STATE AND RESPONSE TO CLOMIPHENE IN AMENORRHOEA

In 246 women with amenorrhoea we compared the result of the progestogen challenge test (menstrual response to oral medroxyprogesterone acetate 5 mg daily for 5 days) (225 patients) with the serum oestradiol‐17β (E2) concentration (154 patients) and with clinical assessment of the oestrogen state of the lower genital tract (183 patients) and related them to the response to clomiphene (188 patients). Ovulation in response to clomiphene was defined essentially by a mid‐luteal serum progesterone concentration of at least 25 nmol/l. E2 values were only useful when they fell below 150 pmol/l; they then indicated that ovulation was very unlikely to occur after clomiphene (2 per cent). Clinical assessment was also only useful in predicting failure to ovulate with clomiphene. However, the progestogen challenge test gave good prediction of ovulatory as well as anovulatory responses to clomiphene. After absent or scanty bleeding following progestogen, only 4 per cent of our patients ovulated, and repeated treatment with clomiphene did not increase the ovulatory rate. After a normal menstrual response to progestogen, 39 per cent ovulated in their first cycle with clomiphene using only 50 mg daily, this proportion rising to 55 per cent if 100 mg was used, and to 75 per cent after treatment for three cycles.