From the Guidelines
Alternative treatments for amenorrhea beyond Oral Contraceptive Pills (OCPs) include progestin therapy, ovulation induction, and lifestyle modifications. The most recent and highest quality study 1 suggests that non-pharmacological treatment strategies should be prioritized, particularly focusing on achieving resumption of menses, given the importance of menses and normal estrogen status to bone health. Some key alternatives include:
- Progestin therapy using medications like medroxyprogesterone acetate (Provera) 10mg daily for 10-14 days or norethindrone acetate 5mg daily for 10-14 days to induce withdrawal bleeding.
- Ovulation induction with clomiphene citrate (50-100mg on cycle days 5-9) or letrozole (2.5-7.5mg on cycle days 3-7) for women desiring pregnancy.
- Gonadotropin therapy with FSH injections for more resistant cases.
- Dopamine agonists like bromocriptine (2.5mg daily) or cabergoline (0.25-1mg twice weekly) for amenorrhea caused by hyperprolactinemia.
- Weight management, stress reduction techniques, and moderate exercise to help normalize hypothalamic function.
- Nutritional interventions, including adequate caloric intake and balanced macronutrients, particularly for athletes or those with eating disorders. It's essential to address the underlying cause of amenorrhea, whether it's hypothalamic dysfunction, polycystic ovary syndrome, thyroid disorders, or other conditions, as this provides the most effective resolution 1.
From the FDA Drug Label
Clomiphene citrate is indicated for the treatment of ovulatory dysfunction in women desiring pregnancy. Those patients most likely to achieve success with clomiphene therapy include patients with polycystic ovary syndrome, amenorrhea-galactorrhea syndrome, psychogenic amenorrhea, post-oral-contraceptive amenorrhea, and certain cases of secondary amenorrhea of undetermined etiology.
Another treatment for amenorrhea besides Oral Contraceptive Pills (OCPs) is clomiphene citrate. This medication is specifically indicated for the treatment of ovulatory dysfunction in women, including those with amenorrhea. Key points to consider include:
- Patient selection: Clomiphene citrate is indicated in patients with demonstrated ovulatory dysfunction who meet specific conditions, such as not being pregnant and having normal liver function.
- Therapy duration: Long-term cyclic therapy is not recommended beyond a total of about six cycles.
- Monitoring: Properly timed coitus in relationship to ovulation is important, and a basal body temperature graph or other tests may help determine if ovulation occurred 2.
From the Research
Alternative Treatments for Amenorrhea
Besides Oral Contraceptive Pills (OCPs), there are other treatment options available for amenorrhea. These include:
- Bromocriptine: a drug that can be safely administered by a family physician to treat amenorrhea, particularly in cases of post-pill amenorrhea 3
- Clomiphene: another effective drug for treating amenorrhea, especially in women who wish to become pregnant 3, 4
- Gonadotrophins: may be used to treat amenorrhea in women who wish to become pregnant 4
Management of Amenorrhea
In some cases, women with amenorrhea may not require treatment, especially if they do not wish to become pregnant. These women can be managed with:
- Reassurance: expecting a spontaneous return of menstruation 3
- Periodic follow-ups: including progesterone withdrawal testing to monitor their condition 3
Hormone Replacement Therapy
For postmenopausal women, hormone replacement therapy (HRT) may be used to treat amenorrhea. A study found that continuous oral estrogen and progestogen therapy can achieve amenorrhea in most women, while also protecting the endometrium from estrogenic over-stimulation 5