Therapeutic target
Normalization of the cycle interval
Therapy recommendations
Treatment depending on the causative disorder and dependence:
- On the prevention of hormone deficiency symptoms or hormone deficiency diseases.
- From the desire to have children
- From the desire for contraception (desire of contraception).
- Of cosmetic desires (acne, hirsutism / excessive hair growth with male distribution pattern).
- See also under “Other therapy“.
If applicable, for the following clinical pictures:
- Hyperandrogenemia (excess male sex hormones): PCO syndrome (polycystic ovary syndrome: symptom complex characterized by hormonal dysfunction of the ovaries (ovaries)), Late Onset AGS (adrenogenital syndrome; congenital disorder of hormone production of the adrenal cortex), Disorder of Sex Development (formerly: intersex) (the onset of therapy occurs in early adolescence).
- Hyperprolactinemia (elevation of prolactin levels in the blood): idiopathic, psychotropic drugs, prolactinoma (benign tumor (adenoma) of the anterior pituitary gland that produces prolactin).
- Hypergonadotropic ovarian failure (primary ovarian failure/ovarian insufficiency, as a result FSH and LH levels are elevated): Autoimmune diseases, chemotherapy, gonadal dysgenesis (maldevelopment of the ovaries), radiatio (radiation therapy).
- Normo-/hypogonadotropic ovarian insufficiency: post-pill amenorrhea (absence of menstruation after taking the birth control pill), stress, sports, eating disorders, severe general illness, massive hypothyroidism (underactive thyroid) or hyperthyroidism (hyperthyroidism; see d. for therapy), pituitary lesions, Kallmann syndrome (genetic dysfunction of the hypothalamus).
Medication:
- Contraceptive desire; treatment with estrogen-progestin combinations in:
- Hyperandrogenemia, hyperprolactinemia, normo/hypogonadotropic ovarian failure.
- For prevention of hormone deficiency symptoms or hormone deficiency diseases.
- Monopreparations when the uterus (womb) is absent.
- Preparations, if the uterus is preserved: estrogens + progestins monophasic or sequential.
- Hyperandrogenemia and cosmetic desires; treatment with: Estrogen-progestin preparations (with an antiandrogenic progestin: chlormadinone acetate; cyproterone acetate; dienogest; drospirenone).
- Hyperprolactinemia and infertility; treatment with: Prolactin inhibitors (dopamine agonists).
- Insulin resistance (decreased effectiveness of endogenous insulin at target organs skeletal muscle, adipose tissue, and liver); treatment with: Metformin (biguanides)
- Late-Onset AGS; treatment with: Glucocorticoids
Further notes
- See use of metformin before and during pregnancy in women with PCOS and childbearing under statement of the German Society of Gynecology and Obstetrics (DGGG).
- Note: Metformin use in the 1st trimester (third trimester) leads to increased risks of adverse pregnancy outcome only in the presence of preexisting diabetes:
- When all indications are included – compared without metformin exposure: increased rate of congenital malformations (5.1% versus 2.1%) and miscarriages and abortions (20.8% versus 10.8%)
- With known diabetes mellitus – compared to all unexposed: increased rate of congenital malformations (7.8% versus 1.7% (n. s.)) and miscarriages and abortions (24.0% versus 16.8% (n. s.))
