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PSYCHOLOGICAL FACTORS, PSYCHIATRIC ILLNESS AND AMENORRHOEA AFTER ORAL CONTRACEPTIVE TREATMENT

The occurrence and causative role of psychological factors reported as hypothalamic amenorrhea that may be present in amenorrhea after discontinuing oral contraceptive (OC) medication was studied. Patients were 75 17-30 year old women with at least 6 months amenorrhea immediately following discontinuance of OC therapy. All of the women volunteered for a standardized psychiatric interview preceded by psychological testing using Form B of the Eysenck Personality Inventory and the Marke-Nyman Temperament Scale. Regular menstrual periods before OC treatment were reported by 46 women. The other 29 had irregular cycles usually with oligomenorrhea with intervals of 4-12 weeks. Of the 46 women with regular cycles 13 reported sporadic cycles of secondary amenorrhea lasting 2-6 months. Of the 29 reporting irregular cycles 9 had similar short periods of amenorrhea. Dysmenorrhea was reported by 38 women. Most of these had been relieved by OC therapy. A ll but 5 were nullipara. Duration of OC treatment had been 2-64 months. Combined type preparations were mostly used. 10 women with syndromes of emotional instability during OC treatment were relieved of symptoms after discontinuance of the treatment. Duration of the amenorrhea in patients studied had ranged from 6 to 49 months. Only 15 women resumed spontaneous menstruation within 12 months after discontinuing OC treatment. The duration of amenorrhea and the length of the treatment period seemed unrelated. Phobias or compulsive behavio r were found in 9 only 1 of them being incapacitated. Periods of insomia had occurred in 31. Women who had experienced stressful life events had higher neuroticism scores and lower solidity scores (p less than .05). The possible importance of other factors is noted as many of the women had not developed amenorrhea on previous occasions when they had discontinued OCs. Women with a previous disturbance of the hypothalamic-pituitary-ovarian axis such as oligomenorrhea were found in greater proportion than expected. All cases in the series of 75 were diagnosed as hypothalamic. It is suggested that emotional factors may play a considerable role in the genesis of amenorrhea after the use of an OC agent. The value of a psychiatric interview is stressed in estimating etiological factors in secondary amenorrhea irrespective of its relation to discontinuance of OC therapy.