EVEN AFTER PRIMING WITH OVARIAN-STEROIDS OR PULSATILE GONADOTROPIN-RELEASING-HORMONE ADMINISTRATION, NALTREXONE IS UNABLE TO INDUCE OVULATION IN WOMEN WITH FUNCTIONAL HYPOTHALAMIC AMENORRHEA

In functional hypothalamic amenorrhea (HA), it has been reported that administration of opioid receptor antagonists restores gonadotropin secretion and ovarian function. However, endogenous opioids may modulate gonadotropin secretion only in the presence of ovarian steroids. To further study these conflicting results, a group of nine women with secondary functional HA who wished to become pregnant were studied. The opiate antagonist naltrexone (Nal; 100 mg/day) was administered for two 30-day periods, starting on either day 22 (Nal 1) of a well characterized replacement regimen with estradiol (E(2)) and progesterone (P) or on day 22 (Nal 2) of the luteal phase induced by erogenous pulsatile GnRH administration (10 mu g/pulse, iv, every 90 min). Plasma LH and FSH were measured every 10 min for 8 h before treatment and on day 12 of each treatment period (Nai 1, pulsatile GnRH, and Nal 2). Ovulation was monitored during each treatment. Plasma E(2) levels were measured on days 12 and 22, and P levels on day 22 of each treatment. During exogenous E(2) and P administration, plasma steroid levels reached luteal phase levels. However, during Nal 1, plasma E(2) levels fell to prestudy levels and remained low. No follicular growth occurred, and the pulsatile study showed pretreatment frequency, amplitude, and mean plasma levels of LH. On day 12 of pulsatile GnRH administration, plasma E(2) levels increased, and LH and FSH pulses followed each GnRH pulse during the frequent sampling study. Ovulation occurred in all women during pulsatile GnRH treatment. During Nal 2 treatment, plasma E(2) levels returned to prestudy levels without follicular growth, and the pulsatile study was similar to those prior treatment and during Nai 1 administration. In conclusion, Nal, started during priming either with exogenous E(2) and P treatment or gonadotropin stimulation induced by pulsatile GnRH administration, was unable when continued alone to initiate or maintain gonadotropin secretion in women with HA. Thus, the exclusive role of opioids in HA and the effect of Nal even in the presence of ovarian steroids are questionable.