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Secondary amenorrhea
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Secondary amenorrhea

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Amenorrhea - secondary; No periods - secondary; Absent periods - secondary; Absent menses - secondary; Absence of periods - secondary

Secondary amenorrhea occurs when a woman who has been having normal menstrual cycles stops getting her periods for 6 or more months.

Women who are pregnant, breastfeeding, or in menopause are not considered to have secondary amenorrhea.

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  • Causes

    Women who are taking birth control pills or who receive hormone shots such as Depo-Provera may not have any monthly bleeding. When they stop taking these hormones, their periods may not return for more than 6 months.

    You are more likely to have amenorrhea if you:

    • Are obese
    • Exercise too much and for long periods of time
    • Have very low body fat (less than 15% - 17%)
    • Have severe anxiety or emotional distress
    • Lose a lot of weight suddenly (such as with strict or extreme diets or after gastric bypass surgery)

    Other causes include:

    • Brain (pituitary) tumors
    • Chemotherapy drugs for cancer
    • Drugs used to treat schizophrenia or psychosis
    • Overactive thyroid gland
    • Polycystic ovarian syndrome
    • Reduced function of the ovaries

    Also, procedures such as a dilation and curettage (D and C) can lead to scar tissue formation that may cause a woman to stop menstruating. This is called Asherman syndrome. Scarring may also be caused by some severe pelvic infections.

  • Symptoms

    In addition to having no menstrual periods, other symptoms can include:

    • Breast size changes
    • Weight gain or weight loss
    • Discharge from the breast (galactorrhea) or change in breast size
    • Increased hair growth in a "male" pattern (hirsutism) and acne
    • Vaginal dryness
    • Voice changes

    If amenorrhea is caused by a pituitary tumor, there may be other symptoms related to the tumor, such as vision loss and headache.

  • Exams and Tests

    A physical exam and pelvic exam must be done to check for pregnancy. A pregnancy test will be done.

    Blood tests may be done to check hormone levels, including:

    • Estradiol levels
    • Follicle stimulating hormone (FSH level)
    • Luteinizing hormone (LH level)
    • Prolactin level
    • Serum hormone levels such as testosterone levels
    • Thyroid stimulating hormone (TSH)

    Other tests that may be performed include:

    • CT scan or MRI scan of the head to look for tumors
    • Biopsy of the lining of the uterus
    • Genetic testing 
    • Ultrasound of the pelvis or hysterosonogram
  • Treatment

    Treatment depends on the cause of the amenorrhea. Normal monthly periods usually return after the condition is treated.

    A lack of menstrual period due to obesity, vigorous exercise, or weight loss may respond to a change in exercise routine or weight control.

  • Outlook (Prognosis)

    The outlook depends on the cause of amenorrhea. Many of the conditions that cause secondary amenorrhea will respond to treatment.

  • When to Contact a Medical Professional

    Call for an appointment with your primary health care provider or women's health provider if you have missed more than one period so that you can get diagnosed and treated, if necessary.

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References

Lobo RA. Primary and secondary amenorrhea and precocious puberty: etiology, diagnostic evaluation, management. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Mosby Elsevier; 2012:chap 38.

Bulun SE. The physiology and pathology of the female reproductive axis. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 17.

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Review Date: 5/31/2012  

Reviewed By: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington; and Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

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