Andrew E. Good

Diagnostic options for assessment of postmenopausal bleeding

Postmenopausal women should undergo endometrial assessment when bleeding occurs in the absence of replacement hormone therapy, after a 1-year regimen of continuous-combined hormone replacement therapy, or at an unexpected time during cyclic replacement therapy. Endometrial assessment can be accomplished by endometrial biopsy, transvaginal ultrasonography, or hysteroscopy. Dilation and curettage should be reserved for those rare cases when the other methods are infeasible. Each method of assessment has advantages and disadvantages, and the choice of method should be made accordingly.

Prolonged over-suppression syndrome.

The syndrome of postpill amenorrhea was investigated retrospectively by studying records of diagnosed cases of amenorrhea (1300) treated or confirmed at the Mayo Clinic. Data are taken from records dating to 1960 (low use of contraceptives) and terminate in 1971. 12 cases are reviewed which were diagnosed as prolonged oversuppression syndrome. No particular oral contraceptive formulation was implicated. 4 of 12 patients had had irregular menstrual cycles before oral contraceptive therapy; whereas 8 had had regular cycles. Bioassay of urinary gonadotropins were consistently in the mid-low normal limits (only 1 determination was available for each patient); some patients had been radioimmunoassayed (single assay) for other pituitary hormones: LH (luteinizing hormone) was at normal basal levels and FSH (follicle stimulating hormone) was also in the normal range. Concentrations of total circulating estrogens were in low or subnormal range in each case. 4 cases had associated galactorrhea, which was attributed to exogenous steroid suppression of the prolactin-inhibiting center of the pituitary. Clomiphene citrate was used to restore functions of the hypothalamic-pituitary axis, and of the 8 receiving clomiphene, 5 responded and 2 conceived.

Estrogens and Progestogens in Clinical Practice

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Gynecology in Primary Care

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Molecular Forms of Human Chorionic Gonadotropin in Serum, Urine, and Placental Extracts**Supported by Grant HD 9140 from the National Institutes of Health and by the Mayo Foundation.††Presented at the Thirty-Second Annual Meeting of The American Fertility Society, April 5 to 9, 1976, Las Vegas, Nev.

The molecular forms of human chorionic gonadotropin (hCG) were assessed in serum, urine, and placental extracts by gel filtration chromatography using radioimmunoassays for hCG, hCGalpha, and hCGbeta and a radioreceptor assay for hCG. The predominant form in all three biologic specimens was native-sized hCG. An excess of free alpha-subunit was also found in all three specimens. A small molecular weight fragment, reactive in the hCGbeta assay, was noted in urine and placental extracts. A large molecular form, reactive in all three radioimmunoassays and in the radioreceptor assay, was found in placental extracts. This large molecular species could not be dissociated by conditions that totally dissociate hCG.