Secondary Amenorrhea: A Guide for Patients

What is Secondary Amenorrhea?

• Secondary amenorrhea is the absence of menstrual periods for three months or more in someone who previously had regular cycles, or for six months in someone with irregular cycles. It is different from primary amenorrhea, which occurs when a person has never had a menstrual period.

Causes of Secondary Amenorrhea

Hormonal Causes:

• Pregnancy: The most common reason for missed periods.
• Menopause or Perimenopause: Natural hormonal changes that stop menstrual cycles.
• Polycystic Ovary Syndrome (PCOS): A hormonal imbalance that disrupts ovulation.
• Thyroid Disorders: Both hyperthyroidism (overactive thyroid) and hypothyroidism (underactive thyroid) can affect periods.
• High Prolactin Levels: A hormone imbalance often caused by a benign pituitary gland tumor.

Lifestyle and Medical Factors:

• Stress: Physical or emotional stress can temporarily stop menstruation.
• Excessive Exercise: Athletes or those with very intense workout routines may experience missed periods.
• Low Body Weight or Eating Disorders: Conditions like anorexia or bulimia can halt menstruation.
• Obesity: Excess weight can interfere with hormone regulation.
• Medications: Birth control, antipsychotics, and chemotherapy drugs can impact menstrual cycles.

Structural Causes:

• Uterine Scarring (Asherman’s Syndrome): Scarring from surgeries like dilation and curettage (D&C) can prevent normal menstruation.
• Ovarian Failure (Premature Menopause): Loss of ovarian function before age 40.

Symptoms Associated with Secondary Amenorrhea

• No menstrual periods for three or more months
• Hot flashes or night sweats (if related to menopause or ovarian failure)
• Excess facial or body hair (if caused by PCOS)
• Milky nipple discharge (if due to high prolactin levels)
• Weight changes (weight gain or loss depending on the cause)

Diagnosis

• Pregnancy test to rule out pregnancy
• Blood tests to check hormone levels (thyroid, prolactin, estrogen, and more)
• Pelvic ultrasound to examine the ovaries and uterus
• MRI or CT scan if a pituitary tumor is suspected

Treatment Options

• Lifestyle changes: Managing stress, maintaining a healthy weight, and adjusting exercise routines.
• Hormonal therapy: Birth control pills, hormone replacement therapy (HRT), or medications to stimulate ovulation.
• Treatment for underlying conditions: Thyroid medications, PCOS management, or surgery for uterine scarring.

When to See a Doctor

• If you have missed three or more periods, experience symptoms of hormonal imbalance, or have difficulty getting pregnant, schedule an appointment with a gynecologist. Early evaluation can help identify the cause and provide effective treatment.

   

  For more information or to schedule an appointment, contact our office today.