Secondary amenorrhea
Key points
- Secondary amenorrhea is a condition in which menstruation begins at the appropriate age, but later ceases for 6 or more months in the absence of normal causes such as pregnancy, lactation, or menopause.
- Pregnancy is often the first thought when a period is missed, but there are many reasons for having a late period.
- Note: Other symptoms associated with amenorrhea depend on the cause.
- The physical examination will probably include a pelvic examination.
Alternative names
Amenorrhea - secondary
Definition
Secondary amenorrhea is a condition in which menstruation begins at the appropriate age, but later ceases for 6 or more months in the absence of normal causes such as pregnancy, lactation, or menopause.
Causes, incidence, and risk factors
Pregnancy is often the first thought when a period is missed, but there are many reasons for having a late period. Increased risk is associated with extreme and prolonged exercise (particularly without adequate conditioning), body fat content less than 15% to 17%, extreme Obesity, and taking hormonal supplements.
Anxiety over a possible pregnancy may cause a missed period, thereby increasing the anxiety even further. Emotional distress from other causes can also cause a missed period.
Drugs such as busulfan, chlorambucil, cyclophosphamide, oral contraceptives, phenothiazines, and non-oral contraceptives (such as Norplant and Depo-Provera) can all cause scanty or missed periods. Also, procedures such as a dilation and curettage (D and C) can cause a woman to develop amenorrhea if scar tissue develops within the uterine cavity.
Early appearance of menopause may account for some cases (menopause is normal for women over age 45).
The incidence of secondary amenorrhea (due to some cause other than pregnancy) is about 4% in the general population.
Symptoms
- Previously had one or more menstrual periods
- No menstrual period for 6 months or longer
Note: Other symptoms associated with amenorrhea depend on the cause. They may include headache, Galactorrhea (breasts produce milk in a woman who is not pregnant or breast feeding an infant), marked weight gain or Weight loss, dry vagina, increased hair growth in a "male" pattern (hirsutism), voice changes, and breast size changes. If amenorrhea is caused by a Pituitary tumor, other symptoms related to the tumor, such as visual loss, may be present.
Signs and tests
The physical examination will probably include a pelvic examination. Physical and pelvic examinations must rule out pregnancy before other diagnostic testing begins. The patient may be encouraged to discuss her fears and, if indicated, may be referred for psychological counseling.
Diagnostic tests that may be performed include:
Written and revised by
Andrey Nailor, M.D.
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