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Alternative Names Return to topAmenorrhea - secondary
Definition Return to top
Secondary amenorrhea is lack of periods for 6 or more months in a woman who has already started menstruation and who is not pregnant, breastfeeding, or in menopause.
Causes Return to top
There are many reasons for missing a period. Polycystic ovarian syndrome is a frequent cause of secondary amenorrhea.
You are also more likely to have secondary amenorrhea if you engage in extreme and prolonged exercise, have less than 15 - 17% body fat, are obese, or take hormonal supplements.
Other causes include:
The following drugs may also cause missed periods:
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.
Symptoms Return to top
Other symptoms associated with secondary amenorrhea depend on the cause. They may include:
If amenorrhea is caused by a pituitary tumor, other symptoms related to the tumor such as visual loss, may be present.
Exams and Tests Return to top
A physical exam and pelvic exam must be done to rule out pregnancy. A pregnancy test will be done.
Blood tests may be done to check hormone levels. Tests may include:
Other tests that may be performed include:
You may be referred to a psychologist if your doctor believes anxiety may be causing the condition.
Treatment Return to top
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.
Outlook (Prognosis) Return to top
The outcome depends on the cause. Most of the conditions that cause secondary amenorrhea will respond to treatment.
Possible Complications Return to top
Depending on the cause, amenorrhea may be harmless, or it may be associated with overgrowth of the uterine lining, a condition called endometrial hyperplasia. This can sometimes lead to uterine cancer.
There may be other complications, depending on the cause of the amenorrhea.
When to Contact a Medical Professional Return to top
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 Return to top
Prevention depends on the cause. For example, moderate exercise instead of extreme exercise, weight control, and other measures may be helpful.
References Return to top
Lobo RA. Abnormal uterine bleeding: ovulatory and anovulatory dysfunctional uterine bleeding, management of acute and chronic excessive bleeding. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, PA: Mosby Elsevier; 2007:chap. 37.
Master-Hunter T, Heiman DL. Amenorrhea: evaluation and treatment. Am Fam Physician. 2006;73(8):1374-1382.Update Date: 6/26/2008 Updated by: Susan Storck, MD, FACOG, Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine; Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.