Amenorrhea. Secondary

General Illness Information


Common Name:

AMENORRHEA, SECONDARY

Medical Term: None specified

Description: Absence of menstruation for at least 3 months in a woman who has previously menstruated.

Causes: Causes may include:

  • Pregnancy;
  • Breast-feeding;
  • Discontinuing use of birth-control pills;
  • Menopause;
  • Emotional stress or psychological disorder;
  • Surgical removal of the ovaries or uterus;
  • Disorder of the endocrine system, including the pituitary, hypothalamus, thyroid, parathyroid, adrenal and ovarian glands (Polycystic ovarian syndrome);
  • Asherman’s syndrome (scarring of the uterine lining from infection or surgery);
  • Diabetes mellitus;
  • Tuberculosis;
  • Obesity, anorexia nervosa or bulimia;
  • Strenuous program of physical exercise, such as long-distance running.

Prevention: If the cause of amenorrhea is unknown, there are no specific preventive measures. Maintain proper nutrition and body weight.

Signs & Symptoms

Lack of menstrual periods after puberty. Most girls begin menstruating by age 14, average age is 12 years and 8 months.

Risk Factors

  • Stress;
  • Use of medications, including oral contraceptives, anticancer drugs, barbiturates, narcotics, cortisone;
  • Excessive exercise;
  • Family history to start menstruation late;
  • Excessive dieting or weight loss.

Diagnosis & Treatment

General Measures:

Diagnostic tests may include:

  • A thorough history and physical examination and to determine the development of secondary sexual characteristics;
  • Laboratory studies of blood samples to check for hormone levels such as prolactin, estrogen, follicle stimulating hormone, luteinizing hormone plus thyroid and adrenal function studies;
  • X-rays and CT scan of the head to rule out pituitary tumor;
  • Ultrasound of the abdomen to look for tumors of the ovary or the adrenal glands;
  • Psychotherapy or counseling, if amenorrhea is stress-related or results from eating disorders.

Medications &amp Treatment:

  • You may be prescribed progesterone (hormone) treatment to induce bleeding. If bleeding begins when progesterone is withdrawn, the reproductive system is functioning. This also indicates that pituitary disease is unlikely. If progesterone withdrawal does not induce bleeding, gonad stimulants such as clomiphene or gonadotropins may be used for the same purpose;
  • Treatment usually involves hormone replacement therapy. Treatment for amenorrhea not related to hormone deficiency depends on the cause;
  • Surgery (minor) to create an opening in the hymen, if necessary.

Activity:

No restrictions. Exercise regularly, but not to excess. Sleep at least 8 hours every night.

Diet:

  • Eat 3 well-balanced meals a day;
  • If you are overweight or underweight, get medical advice about diets. Don’t try to lose weight by crash dieting.

Possible Complications:

  • Psychological distress about sexual development;
  • Inability to conceive

Prognosis

The absence of menstruation is not a health risk in itself, but that it should be identified and treated. Amenorrhea is usually curable with hormone treatment or by treatment of the underlying cause. Treatment may be delayed to age 18 unless the cause can be identified and treated safely. Causes that sometimes cannot be corrected include chromosome disorders.

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