Secondary Amenorrhea (Absent Menstrual Periods) – Causes, Symptoms, Diagnosis, And Treatment


What is secondary amenorrhea?
Amenorrhea is an absence of a monthly menstrual period in a woman of productive age. Secondary amenorrhea is an absence of menstrual period for 3 months or longer, in a woman who has been having regular menstrual periods.

What causes secondary amenorrhea?
Natural changes in the body can cause amenorrhea. Pregnancy is the most common cause of secondary amenorrhea. Breastfeeding and menopause can also cause amenorrhea.

Taking birth control pills or receiving hormone shots such as Depo-Provera may also cause amenorrhea.

Asherman syndrome (scarring of the uterus) can also cause amenorrhea. It is a rare condition that occurs when a woman has had several dilation and curettage (D&C) or severe pelvic infections.

The following are the other causes of amenorrhea:

  • Polycystic ovarian syndrome
  • Reduced function of the ovaries
  • Overactive thyroid gland
  • Brain (pituitary) tumors
  • Drugs for cancer treatment
  • Drugs to treat schizophrenia or psychosis

The following factors can increase a woman’s risk for amenorrhea:

  • Obesity
  • Excessive exercise
  • Very low body fat (less than 15 to 17%)
  • Severe anxiety or emotional distress
  • Sudden loss of too much weight
  • Eating disorders

What are the symptoms of amenorrhea?
The following symptoms may occur in addition to not having menstrual periods:

  • Breast size changes
  • Weight gain or weight loss
  • Discharge from the breast or change in breast size
  • Acne and increased hair growth in a male pattern
  • Vaginal dryness
  • Voice changes

If a pituitary tumor causes amenorrhea, symptoms related to the tumor may occur, such as vision loss and headache.

How is amenorrhea diagnosed?
The doctor will perform a pelvic exam as well as a pregnancy test.

The doctor may order the following blood tests to check hormone levels:

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

Some of the following other tests may also be performed:

  • CT scan or MRI scan of the head to look for tumors
  • Ultrasound of the pelvis
  • Hysterosonogram (pelvic ultrasound that involves putting saline solution inside the uterus)
  • Genetic testing
  •  Biopsy of the lining of the uterus

How is amenorrhea treated?
Treatment of amenorrhea depends on what caused the problem. Mostly, regular menstrual periods return after the condition is treated.

If the amenorrhea is caused by obesity, weight loss, or vigorous exercise, periods may return after making changes in exercise routine or weight control (gain or loss, as needed).

This feature is for informational purposes only and is not intended to substitute the expert guidance of a doctor. We advise seeing a doctor if you have any health concerns.

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