Progesterone

Progestins have long been used to induce withdrawal bleeding in women with secondary amenorrhea. Several factors predict the efficacy of progesterone for this purpose. 5 These factors include estrogen concentrations greater than or equal to 35 pg/ mL (128 pmol/L) and endometrial thickness (the greater it is, the greater is the amount of withdrawal bleeding).

The efficacy of progestins for secondary amenorrhea also varies depending on the formulation used. For example, progesterone in oil administered intramuscularly results in withdrawal bleeding in 70% of treated patients, whereas oral MPA induces withdrawal bleeding in 95% of treated patients.15 Table 49-2 identifies the types and doses of progesterones used for inducing withdrawal bleeding in women with secondary amenorrhea. Figure 49-3 illustrates when to consider the use of progesterone for the treatment of amenorrhea.

For all patients experiencing amenorrhea, owing to the negative impact this has on bone health, it is essential that a diet rich in calcium and vitamin D be followed.

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