Alternative Names: Amenorrhea - secondary

Causes, incidence, and risk factors:

About 4% of women have secondary amenorrhea. There are many reasons for�missing a�period.

You are at an increased risk of secondary amenorrhea if you engage in�extreme and prolonged exercise (particularly without adequate conditioning), have�less than 15 - 17% body fat, are�obese, or�take hormonal supplements.

Anxiety and emotional distress can also cause a missed period.

The following drugs may also cause missed periods:�

• Busulfan
• Chlorambucil
• Cyclophosphamide
• Phenothiazines�
• Oral contraceptives
• Non-oral contraceptives such as Depo-Provera

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.

Symptoms:

• Previously had one or more menstrual periods
• No menstrual period for 6 months or longer

Other symptoms associated with secondary amenorrhea depend on the cause. They may include headache, galactorrhea,�considerable 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 doctor will probably do a pelvic examination. Physical and pelvic examinations must rule out pregnancy before other diagnostic testing begins. The patient may be referred for psychological counseling if anxiety is causing the condition.

Diagnostic tests that may be performed include:

• Endometrial biopsy
• Progestin withdrawal
• Prolactin level
• Serum hormone levels such as testosterone levels
• Pregnancy test (serum HCG)
• Follicle stimulating hormone (FSH level)
• Luteinizing hormone (LH level)
• Thyroid stimulating hormone (TSH)
• Karyotype to rule out the presence of Y chromosome abnormality
• CT scan of the head may be done if a pituitary tumor is suspected

Treatment:

Treatment depends on the cause of the amenorrhea. Normal menstrual function usually returns after the primary disorder is treated.

For example, if the primary disorder is hypothyroidism, then amenorrhea will be cured when it is treated with thyroid supplements.

If the primary cause is obesity, vigorous athletics, weight loss, or similar factors, treatment recommendations may include a change in one's exercise routine and weight control.

Support Groups:

Expectations (prognosis):

The outcome depends on the cause. Most of the conditions that cause secondary amenorrhea will respond to treatment.

Complications:

By itself, amenorrhea does not cause complications. However, the conditions that cause amenorrhea may have complications.

Calling your health care provider:

Call for an appointment with your primary health care provider or OB/GYN provider if you are a woman and have missed more than one period so that the cause, and appropriate treatment, can be determined.

Prevention:

Prevention depends on the cause. For example, moderate exercise instead of extreme exercise, weight control, and other measures may be helpful.

References:

Stenchever MA, Droegemueller W, Herbst AR.�Comprehensive Gynecology. 4th ed. St. Louis, Mo: Mosby; 2001:1109-1119.

Rakel P, ed. Conns Current Therapy 2005. 57th ed. Philadelphia, Pa: WB Saunders; 2005:1291-1293.