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Secondary amenorrhea

Amenorrhea - secondary; No periods - secondary; Absent periods - secondary; Absent menses - secondary; Absence of periods - secondary

 

Secondary amenorrhea is when a woman who has been having normal menstrual cycles stops getting her periods for 6 months or longer.

Women who are pregnant, breastfeeding, or in menopause are not considered to have secondary amenorrhea.

Causes

 

Women who take birth control pills or who receive hormone shots such as Depo-Provera may not have any monthly bleeding. When they stop taking these hormones, their periods may not return for more than 6 months.

You are more likely to have amenorrhea if you:

  • Are obese
  • Exercise too much and for long periods of time
  • Have very low body fat (less than 15 - 17%)
  • Have severe anxiety or emotional distress
  • Lose a lot of weight suddenly (for example, from strict or extreme diets or after gastric bypass surgery)

Other causes include:

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

Also, procedures such as a dilation and curettage (D and C) can cause scar tissue to form. This tissue may cause a woman to stop menstruating. This is called Asherman syndrome. Scarring may also be caused by some severe pelvic infections.

 

Symptoms

 

In addition to having no menstrual periods, other symptoms can include:

  • 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 amenorrhea is caused by a pituitary tumor, there may be other symptoms related to the tumor, such as vision loss and headache.

 

Exams and Tests

 

A physical exam and pelvic exam must be done to check for pregnancy. A pregnancy test will be done.

Blood tests may be done to check hormone levels, including:

  • Estradiol levels
  • 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:

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

 

Treatment

 

Treatment depends on the cause of amenorrhea. Normal monthly periods usually return after the condition is treated.

A lack of menstrual period due to obesity, vigorous exercise, or weight loss may respond to a change in exercise routine or weight control (gain or loss, as needed).

 

Outlook (Prognosis)

 

The outlook depends on the cause of amenorrhea. Many of the conditions that cause secondary amenorrhea will respond to treatment.

 

When to Contact a Medical Professional

 

Make an appointment with your primary health care provider or women's health care provider if you have missed more than one period so that you can get diagnosed and treated, if needed.

 

 

References

Bulun SE. The physiology and pathology of the female reproductive axis. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 17.

Lobo RA. Primary and secondary amenorrhea and precocious puberty: etiology, diagnostic evaluation, management. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 38.

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  • Secondary amenorrhea

    Secondary amenorrhea

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  • Normal uterine anatomy (cut section)

    Normal uterine anatomy (...

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  • Absence of menstruation (amenorrhea)

    Absence of menstruation ...

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    • Secondary amenorrhea

      Secondary amenorrhea

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    • Normal uterine anatomy (cut section)

      Normal uterine anatomy (...

      illustration

    • Absence of menstruation (amenorrhea)

      Absence of menstruation ...

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    A Closer Look

     

      Talking to your MD

       

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          Tests for Secondary amenorrhea

           
             

            Review Date: 6/11/2014

            Reviewed By: Cynthia D. White, MD, Fellow American College of Obstetricians and Gynecologists, Group Health Cooperative, Bellevue, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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