Amenorrhea is the absence of menstruation. Secondary amenorrhea occurs when you’ve had at least one menstrual period and you stop menstruating for three months or longer. Secondary amenorrhea is different from primary amenorrhea. It usually occurs if you haven’t had your first menstrual period by age 16.
A variety of factors can contribute to this condition, including:
- birth control use
- certain medications that treat cancer, psychosis, or schizophrenia
- hormone shots
- medical conditions such as hypothyroidism
- being overweight or underweight
Secondary amenorrhea usually isn’t harmful to your health. It can be treated effectively in most cases. But to avoid complications you must address the underlying conditions that cause amenorrhea.
During a normal menstrual cycle, estrogen levels rise. Estrogen is a hormone responsible for sexual and reproductive development in women. High estrogen levels cause the lining of the uterus to grow and thicken. As the lining of the womb thickens, your body releases an egg into one of the ovaries.
The egg will break apart if a man’s sperm doesn’t fertilize it. This causes estrogen levels to drop. During your menstrual period you shed the thickened uterine lining and extra blood through the vagina. But this process can be disrupted by certain factors.
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
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.
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. PCOS can also cause amenorrhea.
Scar tissue that forms due to pelvic infections or multiple dilation and curettage (D and C) procedures can also prevent menstruation.
D and 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. It’s also used to diagnose and treat abnormal uterine bleeding.
Body weight can affect menstruation. Women who are 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 disrupting your normal menstrual cycle. Your menstrual periods will most likely resume once you work through your tension and anxiety.
The primary symptom of secondary amenorrhea is missing several menstrual periods in a row. Women may also experience:
- vaginal dryness
- deepening of the voice
- excessive or unwanted hair growth on the body
- 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.
Your doctor will first want you to take a pregnancy test to rule out pregnancy. Your doctor may then run a series of blood tests. These tests can measure the levels of testosterone, estrogen, and other hormones in your blood.
Your doctor may also use imaging tests to diagnose secondary amenorrhea. MRI, CT scans, and ultrasound tests allow your doctor to view your internal organs. Your doctor will be looking for cysts or other growths on your ovaries or in the uterus.
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 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.