Secondary amenorrhea Health Article

Definition

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:

• Menstruation - Absent
• Primary amenorrhea

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 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:

• Headache
• Galactorrhea
• Considerable weight gain or weight loss
• Vaginal dryness
• Increased hair growth in a "male" pattern (hirsutism)
• Voice changes
• 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

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:

• Follicle stimulating hormone (FSH level)
• Luteinizing hormone (LH level)
• Prolactin level
• Serum hormone levels such as testosterone levels
• Thyroid stimulating hormone (TSH)

Other tests that may be performed include:

• Endometrial biopsy
• Genetic testing
• MRI of the head
• CT scan of the head

You may be referred to a psychologist if your doctor believes anxiety may be causing the condition.