Secondary Amenorrhea

What Is Secondary Amenorrhea?

Amenorrhea is the medical term for the absence of menstruation. “Secondary” refers to menstruation that has occurred at least once but has stopped, typically for six months or longer. This is different from primary amenorrhea, a condition in which a woman does not have her first period by the age of 16.

You must miss at least three to six menstrual periods without pregnancy to be diagnosed with secondary amenorrhea.

A variety of factors can contribute to this condition, including:

  • birth control use
  • certain medications
  • stress

Pregnancy is the most obvious reason women miss periods. However, pregnancy, breastfeeding, and menopause do not cause this condition.

Amenorrhea is not harmful to your health. It can be treated effectively in most cases. However, you must address the underlying conditions that cause amenorrhea to ensure your overall health.

Causes of Secondary Amenorrhea

Estrogen levels rise and cause the lining of the uterus (womb) to grow and thicken during a normal menstrual cycle. Estrogen is a hormone that is responsible for the development of sex characteristics and the reproductive process in women.

Your body releases an egg halfway through the menstrual cycle. If the egg is not fertilized and does not attach to the uterine wall, your hormone levels drop. You shed the uterine lining through the vaginal opening.

However, certain factors can disrupt this process.

Hormonal Imbalances

A hormonal imbalance is the most common cause of this condition. A hormonal imbalance can occur as a result of:

  • tumors on the pituitary gland
  • an overactive thyroid gland
  • low estrogen levels
  • too much testosterone in your body

Testosterone is the primary sex hormone in men. However, it also plays a role in the growth and development of reproductive tissues in women. Testosterone levels that are too high in a woman can result in irregular or absent menstrual periods.

Hormonal birth control can also contribute to secondary amenorrhea. Hormonal birth control pills and Depo-Provera shots (a type of injectable birth control) may cause you to miss periods. Certain drugs and medical treatments, such as chemotherapy and antipsychotic drugs, can also induce amenorrhea.

Structural Issues

Conditions such as polycystic ovary syndrome (PCOS) can cause hormonal imbalances that lead to weight gain and the growth of unwanted hair in some women. PCOS is a condition in which cysts grow on the ovaries. The resulting hormonal imbalance can cause amenorrhea.

Scar tissue that forms as a result of pelvic infections or multiple dilation and curettage (D&C) procedures can also prevent menstruation. D&C involves dilating the cervix and scraping the uterine lining with a spoon-shaped instrument called a curette. This surgical procedure is often used to remove excess tissue from the uterus or to diagnose and treat abnormal uterine bleeding.

Lifestyle Factors

Body weight can play a role in regular menstruation as well. Women who are very overweight or who have less than 15 percent body fat may stop getting periods. This is especially true for athletes who train extensively or excessively. According to the National Institutes of Health (NIH), losing weight very quickly through an extreme diet can also cause secondary amenorrhea (NIH, 2012).

Emotional stress is a non-physical cause of secondary amenorrhea. Your body may respond to extreme stress by temporarily derailing your normal menstrual cycle. Your periods will most likely resume once you work through your tension and anxiety.

Symptoms of Secondary Amenorrhea

The primary symptom of this condition is missing several menstrual periods in a row. Women may also experience:

  • acne
  • vaginal dryness
  • deepening of the voice
  • excessive, unwanted body hair growth (called hirsutism)
  • headaches
  • changes in vision
  • breast discharge

Call your doctor if you have missed more than three consecutive periods, or if any of your symptoms become severe.

Diagnosing Secondary Amenorrhea

You will first need to take a pregnancy test to rule that out as a potential cause. Then your doctor will run a series of blood tests. The blood tests will measure your evels of testosterone, estrogen, and other hormones produced by the pituitary gland.

Your doctor may also use imaging tests to diagnose this condition. Computed tomography (CT) scans, magnetic resonance imaging (MRI) scans, and ultrasound tests allow your doctor to view your internal organs. Your healthcare team will be looking for cysts or other growths on your ovaries or in the uterus.

Treatment for Secondary Amenorrhea

Treatment for this condition varies depending on its cause. Hormonal imbalances can be treated with supplemental or synthetic hormones. Your doctor may remove ovarian cysts, scar tissue, or uterine adhesions that are causing you to miss periods.

Your doctor may also recommend certain lifestyle changes if your weight or exercise routine contributes to your problem. Ask for a referral to a nutritionist or dietitian if necessary. These specialists can help you learn to manage your weight and physical activity goals in a healthy manner.

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