Secondary Amenorrhea: Causes, Symptoms & Diagnosis
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Secondary Amenorrhea

What Is Secondary Amenorrhea?

Amenorrhea is the absence of menstruation. Secondary amenorrhea occurs when you’ve had at least one menstrual period and you stop menstruating for six months or longer. Secondary amenorrhea is different from primary amenorrhea, which occurs if you haven’t had your first menstrual period by age 16.

You must miss at least three to six menstrual periods to be diagnosed with secondary amenorrhea.

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

  • birth control use
  • certain medications that treat cancer, psychosis, or schizophrenia
  • hormone shots

Missed menstrual periods are usually associated with pregnancy, breast-feeding, or menopause. However, these conditions don’t cause amenorrhea.

Secondary amenorrhea usually isn’t harmful to your health. It can be treated effectively in most cases. However, you must address the underlying conditions that cause amenorrhea to prevent any complications.

What Causes Secondary Amenorrhea?

Causes

During a normal menstrual cycle, estrogen levels rise. Estrogen is a hormone that’s responsible for sexual and reproductive development in women. The high estrogen levels cause the lining of the uterus, or womb, to grow and thicken. As the lining of the womb thickens, your body releases an egg into one of the ovaries. When the egg isn’t fertilized by a man’s sperm cell, it will break apart. This causes estrogen levels to drop. You’ll then shed the thickened uterine lining and extra blood through the vagina during your menstrual period.

However, this process can be disrupted by certain factors.

Hormonal Imbalances

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

  • tumors on the pituitary gland
  • an overactive thyroid gland
  • low estrogen levels
  • high testosterone levels

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

Hormonal birth control can also contribute to secondary amenorrhea. Depo-Provera, a hormonal birth control shot, and hormonal birth control pills may cause you to miss menstrual periods. Certain medical treatments and medications, such as chemotherapy and antipsychotic drugs, can also trigger amenorrhea.

Structural Issues

Conditions such as polycystic ovary syndrome (PCOS) can cause hormonal imbalances that lead to the growth of ovarian cysts. Ovarian cysts are benign, or noncancerous, masses that develop in the ovaries. The hormonal imbalances that result from PCOS can also cause amenorrhea.

Scar tissue that forms due to 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 potentially affect regular menstruation as well. Women who are very overweight or who have less than 15 percent body fat may stop getting menstrual periods. This is especially true for athletes who train extensively or excessively.

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

Symptoms of Secondary Amenorrhea

Symptoms

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

  • acne
  • vaginal dryness
  • deepening of the voice
  • excessive or unwanted hair growth on the body
  • headaches
  • changes in vision
  • nipple discharge

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

Diagnosing Secondary Amenorrhea

Diagnosis

Your doctor will first want you to take a pregnancy test to rule out pregnancy. Your doctor will then run a series of blood tests. These tests will measure the levels of testosterone, estrogen, and other hormones in your blood.

Your doctor may also use imaging tests to diagnose secondary amenorrhea. MRI scans, CT scans, and ultrasound tests allow your doctor to view your internal organs in more detail. Your doctor will be looking for cysts or other growths on your ovaries or in the uterus.

Treatment for Secondary Amenorrhea

Treatment

The treatment for secondary amenorrhea varies depending on the underlying cause of your condition. Hormonal imbalances can be treated with supplemental or synthetic hormones. Your doctor may also want to remove ovarian cysts, scar tissue, or uterine adhesions that are causing you to miss your menstrual periods.

Your doctor may also recommend making certain lifestyle changes if your weight or exercise routine is contributing to your condition. Ask your doctor for a referral to a nutritionist or dietitian, if necessary. These specialists can teach you how to manage your weight and physical activity in a healthy manner.

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