From the Guidelines
Secondary amenorrhea, defined as the absence of menstruation for three or more months in a woman who previously had regular periods, requires immediate medical evaluation to determine the underlying cause, with the first step being a pregnancy test, as pregnancy is the most common cause, and if ruled out, a thorough medical assessment should include blood tests to check hormone levels and possibly pelvic imaging, as indicated by 1 and 1.
Causes of Secondary Amenorrhea
The causes of secondary amenorrhea can be diverse, including:
- Stress and stress sensitivity
- Vigorous exercise
- Weight loss
- Psychological disorders
- Polycystic ovary syndrome (PCOS)
- Thyroid disorders
- Hyperprolactinemia
- Premature ovarian insufficiency
- Structural abnormalities As noted in 1, functional hypothalamic amenorrhoea (FHA) is one of the most common underlying conditions, responsible for about 20–35% of cases of secondary amenorrhea.
Diagnostic Approach
The diagnostic approach should include:
- Blood tests to check hormone levels (FSH, LH, estradiol, prolactin, and thyroid function)
- Pelvic imaging
- Assessment of stress levels and lifestyle factors
- Evaluation for PCOS and other underlying conditions As suggested by 1, the combination of amenorrhea and polycystic ovarian morphology (PCOM) can lead to confusion, and a thorough evaluation is necessary to differentiate between FHA-PCOM and PCOS.
Treatment
Treatment depends on the underlying cause, and for stress-related amenorrhea, lifestyle modifications like stress reduction techniques and moderate exercise may help, while for PCOS, combined hormonal contraceptives can regulate periods, as indicated by 1 and 1. Additionally, thyroid disorders require specific thyroid medication, and if low estrogen is causing bone density concerns, hormonal therapy may be recommended. It's essential to seek medical attention promptly, as prolonged untreated amenorrhea can lead to complications like bone loss or endometrial hyperplasia in certain conditions, highlighting the importance of early evaluation and treatment, as emphasized by 1.
From the Research
Definition and Diagnosis of Secondary Amenorrhea
- Secondary amenorrhea is defined as the cessation of regular menses for three months or the cessation of irregular menses for six months 2, 3.
- The initial workup of secondary amenorrhea includes a pregnancy test and serum levels of luteinizing hormone, follicle-stimulating hormone, prolactin, and thyroid-stimulating hormone 2, 3.
- A systematic evaluation including a detailed history, physical examination, and laboratory assessment of selected serum hormone levels can usually identify the underlying cause of secondary amenorrhea 2.
Causes of Secondary Amenorrhea
- Most cases of secondary amenorrhea can be attributed to polycystic ovary syndrome, hypothalamic amenorrhea, hyperprolactinemia, or primary ovarian insufficiency 2.
- Pregnancy should be excluded in all cases of secondary amenorrhea 2, 3.
- Other potential causes of secondary amenorrhea include outflow tract abnormalities, primary ovarian insufficiency, hypothalamic or pituitary disorders, other endocrine gland disorders, sequelae of chronic disease, physiologic, or induced factors 3.
Treatment and Management of Secondary Amenorrhea
- Treatment goals for patients with secondary amenorrhea may vary considerably, and depend on the patient and the specific diagnosis 2.
- Patients with primary ovarian insufficiency can maintain unpredictable ovarian function and should not be presumed infertile 2, 3.
- Patients with hypothalamic amenorrhea should be evaluated for eating disorders and are at risk for decreased bone density 2, 3.
- Patients with polycystic ovary syndrome are at risk for glucose intolerance, dyslipidemia, and other aspects of metabolic syndrome 2, 3.
Note: The study 4 is not relevant to the topic of secondary amenorrhea.