Secondary Amenorrhea

Basic Information

What is Secondary Amenorrhea?

Cessation of menstruation for at least 3 months in a woman who has previously menstruated.

Secondary Amenorrhea signs and symptoms

Absence of menstrual periods for 3 or more months in a woman who has menstruated at least once.

Causes

  • Pregnancy (if the woman has had sexual intercourse).
  • Breast-feeding an infant.
  • Discontinuing use of birth-control pills.
  • Menopause (if the woman is over 35 and not pregnant).
  • Emotional stress or psychological disorder.
  • Surgical removal of the ovaries or uterus.
  • Disorder of the endocrine system, including the pituitary, hypothalamus, thyroid, parathyroid, adrenal and ovarian glands.
  • Diabetes mellitus.
  • Tuberculosis.
  • Obesity, anorexia nervosa or bulimia.
  • Strenuous program of physical exercise, such as longdistance running.

Risk increases with

  • Stress.
  • Poor nutrition.
  • Use of certain drugs, such as narcotics, phenothiazines, reserpine or hormones.
  • Excessive exercise.

Preventive measures

  • If your amenorrhea is caused by an underlying disease, such as tuberculosis, diabetes or anorexia nervosa, obtain treatment for the primary disorder.
  • If the cause of your amenorrhea is unknown, there are no specific preventive measures.
  • Maintain proper nutrition and body weight.

Expected outcomes

Amenorrhea is not a threat to health. Whether it can be corrected varies with the underlying cause:

  • If from pregnancy or breast-feeding, menstruation will resume when these conditions cease.
  • If from discontinuing use of oral contraceptives, periods should begin in 2 months to 2 years.
  • If from menopause, periods will become less frequent or may never resume. Hysterectomy also ends menstruation permanently.
  • If from endocrine disorders, hormone replacement usually causes periods to resume.
  • If from eating disorders, successful treatment of that disorder is necessary for menstruation to resume.
  • If from diabetes or tuberculosis, menstruation may never resume.
  • If from strenuous exercise, periods usually resume when exercise decreases.

Possible complications

  • None expected if no serious underlying cause can be discovered.
  • May experience estrogen deficiency symptoms, such as hot flushes, vaginal dryness.
  • May affect fertility.

Treatment of Secondary Amenorrhea

General measures

  • To aid in diagnosis, laboratory studies, such as a pregnancy test, blood studies of hormone levels and Pap smear are usually necessary. Surgical diagnostic procedures such as laparoscopy or hysteroscopy may be recommended.
  • Dilatation and curettage, often referred to as D & C (dilation of the cervix and a scraping out of the uterus with a curette) may be performed.
  • Treatment of underlying disorder if one is diagnosed.
  • Psychotherapy or counseling, if amenorrhea is related to stress.
  • Keep a record of menstrual cycles to aid in early detection of recurrent amenorrhea.

Medications

  • Therapeutic trial of progesterone and/or estrogen. If bleeding occurs after progesterone is withdrawn, the reproduction system is functional.
  • Other drugs to treat underlying disorder may be prescribed.

Activity

No restrictions.

Diet

  • Usually no special diet.
  • If overweight or underweight, a change in diet to correct the problem is recommended.

Notify your physician if

  • You or a family member has symptoms of amenorrhea.
  • Periods don't resume in 6 months, despite treatment.
  • New, unexplained symptoms develop. Hormones used in treatment may produce side effects.

Last updated 8 August 2011


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