Secondary Amenorrhea
Amenorrhea can be classified into two types:
Primary amenorrhea: Here the patient has never had regular menstrual cycles in her life.
Secondary amenorrhea: This refers to women who have missed three or more periods after their regular menstrual cycle has been established.
The most common cause of secondary amenorrhea is pregnancy. However, there may be other causes of secondary amenorrhea as well.
In most cases the cause of amenorrhea is not ovulating (anovulation) because there is a problem either in the ovaries, or centrally in the brain.
Other problems of amenorrhea include problems in the vagina and uterus.
Causes of Anovulation
The major cause of not ovulating (anovulation) are:
- Pregnancy (the most common cause)
- PCOS: Polycystic ovarian syndrome
- Emotional stress
- Being overweight
- Being underweight
- Low thyroid (hypothyroid)
- Premature ovarian failure (menopause before age 40)
- Stopping birth control pills (‘Post-Pill Amenorrhea’)
- An elevated prolactin level (e.g. pituitary gland tumors, prolactinomas)
- Endocrine disorders such as Cushing’s syndrome (in which there are very high levels of cortisol, an adrenal hormone) or hyperthyroidism (abnormally high levels of thyroid hormone)
- Frequent strenuous exercise
- Chronic illness, such as colitis, kidney failure or cystic fibrosis
- Chemotherapy for cancer
- Cysts or tumors in the ovaries (rarely)
- Some birth control methods, such as Depo Provera
Although the condition is generally no cause for alarm or emergency, it is better to talk to a doctor at the earliest.
A thorough history and a physical exam, including a pelvic exam needs to be done. The doctor will probably not recommend any tests (such as a blood test to measure hormone levels LH, FSH, thyroid, prolactin) unless:
- You have missed three or more periods in a row.
- You have other symptoms, such as breast milk production, headache, vision changes, trouble with coordination, or excessive growth of body hair.
Treatment
The treatment of amenorrhea depends on its cause.
A diet and exercise program to correct obesity may restore your menstrual periods. Target at attaining an ideal body weight. Learning to manage stress at school or work and decreasing excessive physical exercise is also helpful.
The usual treatment is to take the hormone progesterone for 7 to 14 days every one or two months.
Surgical treatment may be necessary if you have tumors or cysts in your ovaries or uterus, or if your vagina is shaped abnormally or has no opening.
Avoid excessive use of alcohol and mood-altering stimulants or sedative drugs. Avoid cigarette smoking.
Assess the areas of emotional stress and conflict in your life. If you feel that you cannot resolve these conflicts on your own, ask for help from family, friends, or health professionals.
Moderation in all your activities is the key. Try to balance your work, recreation, and rest.
