Post Danazol Amenorrhoea

Post Danazol Amenorrhoea - IAN S. FRASER In the present study, 242 women were treated with danazol for 3–6 months. Four of these women experienced posttreatment amenorrhea that lasted 6 months or longer. The author describes the four cases in this report. Case 1. The patient, aged 16 years, had severe hormonal mastopathy, increasing over a period of 18 months. Her menstrual cycles had been regular since menarche at age 13. She responded well to danazol (400–600 mg daily for 12 weeks), with only minor side effects, including a weight gain from 54.5–56.0 kg. When danazol therapy was discontinued, she had complete amenorrhea for 2 years. There was no evidence of galactorrhea, headaches, visual disturbances, or hot flushes. After 6 months of amenorrhea, her plasma hormone levels were as follows: FSH, 7 IU/liter (normal range, 2–10 IU/liter); LH, 8 IU/liter (normal, 2–12 IU/liter); prolactin, 3 ng/ml (normal, 4–15 ng/ml). TSH and thyroid function tests were normal. These levels were essentially unchanged after 18 months, and spontaneous cure occurred 2 years after cessation of danazol treatment. Case 2. The patient, aged 28 years, had a normal menarche at age 15 and a history of fairly regular menstrual cycles. She had used Depo-Provera (The Upjohn Company, Kalamazoo, Ml), (150 mg every 3 months) as a contraceptive for 5 years until age 27. She had one menstrual period 8 months after stopping the drug, and shortly thereafter presented with a bowel obstruction, diagnosed at laparotomy as due to endometriosis. She was treated with danazol (600 mg daily for 6 months) with good results. She experienced vaginal bleeding 4 days after stopping danazol and then developed amenorrhea, which lasted for 14 months. The patient tried to become pregnant, and ovulation eventually was induced at 14 months with clomiphene (200 mg daily for 5 days). The attempt was not successful, and she quit trying because of relationship problems. Case 3. The 38-year-old patient had a normal menarche at age 14 and mild oligomenorrhea (5− to 6-week cycles) most of her life. Endometriosis had caused pelvic pain, dysmenorrhea, dyspareunia, and primary infertility, and two conservative laparotomies had been performed to treat endometriosis and adhesions. Typical polycystic ovary disease had been diagnosed also, with plasma LH of 24 lU/liter and FSH of 7 lU/liter. The patient was treated with danazol (400 mg daily for 6 months) with excellent symptomatic results. Side effects were few except for a moderate weight gain from 87.2–94.1 kg. The patient experienced 5 months of complete amenorrhea after danazol treatment, followed by severe oligomenorrhea (four periods in 1.5 years). There were no unusual symptoms. Case 4. This patient was 32 years old. Menarche at age 14 was normal and followed by regular menstrual cycles. Primary infertility, which she had had for 9 years, was found at laparoscopy to be due to endometriosis. She was treated for 6 months with danazol (800 mg daily) with troublesome side effects of acne, greasy skin, muscle cramps, and a weight gain from 54.2–58.6 kg. The patient then experienced amenorrhea for 13 months, with no unusual symptoms. Ovulation was induced with clomiphene (50 mg/day for 5 days), and she became pregnant 26 months after stopping danazol. Plasma hormone levels at 10 months were as follows: FSH, 9 lU/liter; LH, 7 IU/liter; prolactin, 6 ng/ml. The striking endocrine findings was an abnormal transient elevation of plasma, FSH, during the early months following danazol therapy in two cases. The rise in FSH well into the post menopausal range was not accompanied by a rise in LH. The rise persisted in 4–5 months in each case and was associated with an increase in the pituitary pool of releasable FSH demonstrated by GnRH injection as would be expected in women with ovarian failure.