Post-combined hormonal contraception (CHC) amenorrhea: our experience
Lara Tiranini (IT), Laura Cucinella (IT), Silvia Martella (IT), Ellis Martini (IT), David Bosoni (IT), Monica Prina (IT), Manuela Piccinino (IT), Rossella Nappi (IT)
[Tiranini] Research Centre for Reproductive Medicine, Gynaecological Endocrinology and Menopause, IRCCS San Matteo Foundation, University of Pavia, Pavia, [Cucinella] Research Centre for Reproductive Medicine, Gynaecological Endocrinology and Menopause, IRCCS San Matteo Foundation, University of Pavia, Pavia, [Martella] Research Centre for Reproductive Medicine, Gynaecological Endocrinology and Menopause, IRCCS San Matteo Foundation, University of Pavia, Pavia, [Martini] Research Centre for Reproductive Medicine, Gynaecological Endocrinology and Menopause, IRCCS San Matteo Foundation, University of Pavia, Pavia, [Bosoni] Research Centre for Reproductive Medicine, Gynaecological Endocrinology and Menopause, IRCCS San Matteo Foundation, University of Pavia, Pavia, [Prina] Research Centre for Reproductive Medicine, Gynaecological Endocrinology and Menopause, IRCCS San Matteo Foundation, Pavia, [Piccinino] Research Centre for Reproductive Medicine, Gynaecological Endocrinology and Menopause, IRCCS San Matteo Foun
Context: Infertility is reported by many women as a possible consequence of combined hormonal contraception (CHC) usage. It is likely that women believe that CHC may induce menstrual abnormalities after its discontinuation. Objectives: We performed a retrospective analysis of some potential factors involved in the manifestation of secondary amenorrhea following CHC discontinuation in women without menstrual abnormalities before prescription. Patients: Out of 608 women who stopped CHC after at least 1-year period of usage between 2015 and 2016, we selected 115 women who displayed regular menstrual cycle at first CHC prescription. They underwent a clinical interview and routinely assessment (ultrasound, basal hormonal profile) for diagnosis and treatment. Results: The rate of secondary amenorrhea (at least 3 months) was 25.2% (n=29) with no significant difference in term of age (median 19 years, IQR: 18-22.2) and months of use (median 24, IQR: 12-36) in comparison with those (n=86) who resumed a regular menstrual cycle (median age: 21 years, IQR: 18-25; median months of use: 20, IQR: 12-35). During CHC assumption, a significant change of body weight (more or less than 5 kg) was evident in women with post-CHC amenorrhea (68.8%) versus those with regular menstrual cycles (27.9%). Indeed, they reported less regular diet (76.6%) and more intense exercise (44.8%) as compared to the others (76.6% and 24.4%, respectively). Amenorrheic women reported more mood disorders (depression, anxiety, etc) in comparison with women resuming their menstrual cycle after CHC discontinuation (72.4% vs 39.5%). Amenorrhea occurred in past 15-20 mcg EE CHC users more frequently as compared to 30 mcg EE (65.5% versus 35.5%). Conclusions: post-CHC amenorrhea may be the result of psychoneuroendocrine variables mostly related to lifestyle and stressful conditions. EE dose may be also involved.