Differential Diagnosis for Secondary Amenorrhea
Single Most Likely Diagnosis
- Polycystic Ovary Syndrome (PCOS): This is often considered the most common cause of secondary amenorrhea due to its high prevalence among women of reproductive age. PCOS leads to hormonal imbalance, ovulation disorders, and consequently, irregular or absent menstrual periods.
Other Likely Diagnoses
- Hypothyroidism: Thyroid dysfunction can disrupt the menstrual cycle, leading to secondary amenorrhea. Hypothyroidism is a common condition that can affect menstrual regularity.
- Hyperprolactinemia: Elevated prolactin levels can suppress the secretion of gonadotropin-releasing hormone (GnRH), leading to decreased estrogen production and amenorrhea.
- Premature Ovarian Failure (POF): Also known as premature ovarian insufficiency, this condition occurs when the ovaries stop functioning and hormone levels decrease before the age of 40, leading to secondary amenorrhea.
Do Not Miss Diagnoses
- Pituitary Tumor: Although rare, a pituitary tumor can cause hyperprolactinemia or disrupt the normal secretion of hormones necessary for menstruation, leading to secondary amenorrhea. Missing this diagnosis could have significant health implications.
- Asherman Syndrome: This condition, characterized by the formation of adhesions in the uterus, can lead to secondary amenorrhea. It often results from uterine surgery, such as a dilation and curettage (D&C), and can be missed if not considered.
- Sheehan Syndrome: A rare but potentially life-threatening condition caused by necrosis of the pituitary gland, usually following severe postpartum hemorrhage. It can lead to hypopituitarism and secondary amenorrhea.
Rare Diagnoses
- Congenital Adrenal Hyperplasia: A group of inherited disorders that affect the adrenal glands, leading to hormone imbalances that can cause secondary amenorrhea.
- Androgen Insensitivity Syndrome: A rare condition where an individual is genetically male (XY chromosomes) but has a partial or complete inability to respond to androgens, leading to the development of female external genitalia but with undescended testes and no uterus, resulting in primary or secondary amenorrhea.
- Gonadal Dysgenesis: A condition characterized by the abnormal development of the gonads (ovaries or testes), which can lead to hormone deficiencies and secondary amenorrhea.