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.

Last updated 8 August 2015