[Favorable reproductive and menstrual evolution in adult women, who presented in the adolescence, menstrual disturbances by hypothalamic dysfunction and lack of response to clomiphene].
BACKGROUND
Hypothalamic dysfunction is a cause of menstrual disturbances in women, in whom other diseases have been discarded. This condition is characterized by a failure of the GNRH pulse generation system and is associated to psychological and environmental factors. A lack of ovulatory response to the administration of clomiphene can be a sign of bad prognosis in hypothalamic dysfunction.


OBJECTIVE
To report the natural history of patients with hypothalamic dysfunction and a bad or deficient response to the administration of clomiphene.


METHODS
Fifty patients with hypothalamic dysfunction, that consulted for menstrual disturbances at the age of 15 to 20 years old, were studied. All received clomiphene and 31 had an ovulatory response, 12 had menses without ovulation and 7 did not menstruate. Of these 19 women eleven were interviewed again about their menstrual and reproductive history, after a lapse of 9 to 17 years of loss from follow up.


RESULTS
Eight of the eleven women had stressful events during adolescence (going away from family house in 3, starting university studies in 3, migration out of the natal country in one and non competitive physical activity in one). All restarted their menses and eight with active sexual life had spontaneous pregnancies, giving birth from two to five children. Ovulatory cycles were documented in women without active sexual life.


CONCLUSIONS
In teenagers with hypothalamic dysfunction and menstrual disturbances, a deficient or bad response to clomiphene does not necessarily indicate a bad prognosis in terms of menses or fertility.
Devoto
Enzo
E
Sección Endocrinología, Departamento de Medicina, Hospital Clínico San Borja Arriarán, Facultad de Medicina (Campus Centro), Universidad de Chile, Santiago de Chile. edevoto@vtr.net
Aravena
Lucía
L
D000293:Adolescent; D000328:Adult; D000568:Amenorrhea / Q000188:drug therapy; D000858:Anovulation / Q000188:drug therapy; D001927:Brain Diseases / Q000150:complications*; D002996:Clomiphene / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007031:Hypothalamus / Q000503:physiopathology*; D007247:Infertility, Female / Q000188:drug therapy* / Q000209:etiology; D008599:Menstruation Disturbances / Q000188:drug therapy* / Q000209:etiology; D010060:Ovulation / Q000187:drug effects; D011374:Progesterone / Q000097:blood; D020845:Selective Estrogen Receptor Modulators / Q000627:therapeutic use*
D020845:Selective Estrogen Receptor Modulators; D002996:Clomiphene; D011374:Progesterone