Secondary amenorrheaDefinition: Secondary amenorrhea is lack of periods for 6 or more months in a woman who has already started menstruation and who is not pregnant, breastfeeding, or in menopause. See also:
Alternative Names: Amenorrhea - secondary
Causes, incidence, and risk factors: There are many reasons for missing a period. Polycystic ovarian syndrome is a frequent cause of secondary amenorrhea. You are also more likely to have secondary amenorrhea if you engage in extreme and prolonged exercise, have less than 15 - 17% body fat, are obese, or take hormonal supplements. Other causes include: - Sudden significant weight loss as seen with strict dieting or after gastric bypass surgery
- Anxiety and emotional distress
- Thyroid dysfunction
- Brain (pituitary) tumors
- Premature ovarian failure
The following drugs may also cause missed periods: - Busulfan
- Chlorambucil
- Cyclophosphamide
- Phenothiazines
- Birth control pills
- Hormone therapy such as Depo-Provera
Also, procedures such as a dilation and curettage (D and C ) can lead to scar tissue formation that may cause a a woman to stop menstruating. This is called Asherman syndrome .
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: If amenorrhea is caused by a pituitary tumor, other symptoms related to the tumor such as visual loss, may be present.
Signs and tests: A physical exam and pelvic exam must be done to rule out pregnancy. A pregnancy test will be done. Blood tests may be done to check hormone levels. Tests may include: Other tests that may be performed include: You may be referred to a psychologist if your doctor believes anxiety may be causing the condition.
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: Depending on the cause, amenorrhea may be harmless, or it may be associated with overgrowth of the uterine lining, a condition called endometrial hyperplasia. This can sometimes lead to uterine cancer. There may be other complications, depending on the cause of the amenorrhea.
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: Lobo RA. Abnormal Uterine Bleeding: Ovulatory and Anovulatory Dysfunctional Uterine Bleeding, Management of Acute and Chronic Excessive Bleeding. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007: chap. 37. Master-Hunter T. Amenorrhea: Evaluation and Treatment. Am Fam Physician. Apr. 2006; 73(8): 1374-82.
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