Trip Answers

Question answered:14/12/07 Warning! this question is over two years old.

In answering this question, we do not know the age of the patient.

 

The CKS guideline on amenorrhoea discusses ‘post-pill’ amenorrhoea and notes:

 

“Amenorrhoea lasting more than 6 months after use of the oral combined contraceptive pill has been stopped should be regarded as coincidental rather than resulting from the use of the pill, and should be investigated as outlined in How do I find the cause of secondary amenorrhoea?.” [1]

 

An e-Medicine article makes similar recommendations in the section disadvantages of the combined oral contraceptive pill:

 

“…A few months of delay of normal ovulatory cycles may occur after discontinuation of OCs. Women who continue to have amenorrhea after a discontinuation period of 6 months require a full evaluation.” [2]

 

A third source, the Patient UK website states:

 

“Post pill amenorrhoea" is when stopping oral contraceptives does not lead to a resumption of a normal menstrual cycle. It usually settles spontaneously in around 3 months but if not it requires investigation. The condition is probably not a true entity but the cause of amenorrhoea started whilst taking the contraceptives that induced an artificial cycle until they were stopped.” [3]

 

Concerning possible complications of amenorrhoea, the CKS guideline lists the following conditions:

 

“Amenorrhoea is a symptom, and complications and prognosis depend on the underlying cause.

 

• “Osteoporosis:
o Women with amenorrhoea associated with oestrogen deficiency are at significant risk of developing osteoporosis. This increased risk persists even if normal menses are resumed. Oestrogen deficiency is of particular concern in adolescents as a desirable peak bone mass may not be attained. Poor nutrition in women with eating disorders may also contribute to the increased risk of osteoporosis [Committee on Sports Medicine, 1989; Fogel, 1997; Warren and Stiehl, 1999].
• Cardiovascular disease:
o Young women with amenorrhoea associated with oestrogen deficiency may be at increased risk of cardiovascular disease; although this has not been studied specifically, the increased risk associated with a low oestrogen state in postmenopausal women is well documented [Kiningham et al, 1996; Fogel, 1997; McIver et al, 1997].
• Infertility:
o Women with amenorrhoea generally do not ovulate, but pregnancy can be achieved in many either by treating the underlying disorder or by specialized infertility treatment [Baird, 1997; McIver et al, 1997]. Between 10% and 20% of women complaining of infertility have amenorrhoea [Franks, 1987].
• Psychological distress:
o Amenorrhoea often causes considerable anxiety, altered self-image, and loss of self-esteem. Many women have concerns about loss of fertility, loss of femininity, or worry about an unwanted pregnancy. The diagnosis of Turner's syndrome, androgen insensitivity syndrome, or developmental anomaly can be traumatic for both girls and their parents [Fogel, 1997; Rees, 1997].”

 

It adds:

 

“Polycystic ovary syndrome (PCOS) is a common cause of secondary amenorrhoea and may be associated with:
cardiovascular disease… diabetes… and endometrial hyperplasia.” [1]

References
1. CKS. Amenorrhoea. January 2007. (http://www.cks.library.nhs.uk/amenorrhoea)
2. Samra O. Contraception. September 2006. (http://www.emedicine.com/med/topic3211.htm#section~hormonal_contraceptives)
3. Patient UK. Amenorrhoea.November 2007. (http://www.patient.co.uk/showdoc/40000034/)

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