Secondary amenorrhea

Definition

Secondary amenorrhea is a condition in which menstruation begins at the appropriate age, but later stops for 6 or more months for reasons not due to pregnancy, lactation, or menopause.

See also:

Menstruation - Absent

Primary amenorrhea

Causes, incidence, and risk factors

About 4% of women have secondary amenorrhea. There are many reasons for missing a period.

You are at an increased risk of secondary amenorrhea if you engage in extreme and prolonged exercise (particularly without adequate conditioning), have less than 15 - 17%, are obese, or take hormonal supplements.

Anxiety  and emotional distress can also cause a missed period.

The following drugs may also cause missed periods: 

• Busulfan
• Chlorambucil
• Cyclophosphamide
• Phenothiazines 
• Oral contraceptives
• Non-oral contraceptives such as Depo-Provera

Also, procedures such as a dilation and curettage (D and C) can cause a woman to develop amenorrhea if scar tissue develops within the uterine cavity.

Symptoms

• Previously had one or more menstrual periods
• No menstrual period for 6 months or longer

Other symptoms associated with secondary amenorrhea depend on the cause. They may include headache, galactorrhea, considerable weight gain or weight loss, dry vagina, increased hair growth in a "male" pattern (hirsutism), voice changes, and breast size changes. If amenorrhea is caused by a pituitary tumor, other symptoms related to the tumor such as visual loss, may be present.

Signs and tests

The doctor will probably do a pelvic examination. Physical and pelvic examinations must rule out pregnancy before other diagnostic testing begins. The patient may be referred for psychological counseling if anxiety is causing the condition.

Diagnostic tests that may be performed include:

• Endometrial biopsy
• Progestin withdrawal
• Prolactin level
• Serum hormone levels such as testosterone levels
• Thyroid function studies
• Pregnancy test (serum HCG )
• Follicle stimulating hormone (FSH level)
• Luteinizing hormone (LH level)
• Thyroid stimulating hormone (TSH)
• Karyotype to rule out the presence of Y chromosome abnormality
• CT scan of the head may be done if a pituitary tumor is suspected

Treatment

Treatment depends on the cause of the amenorrhea. Normal menstrual function usually returns after the primary disorder is treated.

For example, if the primary disorder is hypothyroidism, then amenorrhea will be cured when it is treated with thyroid supplements.

If the primary cause is obesity, vigorous athletics, weight loss, or similar factors, treatment recommendations may include a change in one's exercise routine and weight control.

Expectations (prognosis)

The outcome depends on the cause. Most of the conditions that cause secondary amenorrhea will respond to treatment.

Complications

By itself, amenorrhea does not cause complications. However, the conditions that cause amenorrhea may have complications.

Calling your health care provider

Call for an appointment with your primary health care provider or OB/GYN provider if you are a woman and have missed more than one period so that the cause, and appropriate treatment, can be determined.

Prevention

Prevention depends on the cause. For example, moderate exercise instead of extreme exercise, weight control, and other measures may be helpful.

References

Stenchever MA, Droegemueller W, Herbst AR. Comprehensive Gynecology. 4th ed. St. Louis, MO: Mosby; 2001:1109-1119.

Illustrations

Secondary amenorrhea

Normal uterine anatomy (cut section)

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Amenorrhea - secondary ; secondary amenorrhea; secondary amenorrhea cause