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 problems, and consequently, irregular or absent menstrual periods.
Other Likely Diagnoses
- Hypothyroidism: Thyroid dysfunction can disrupt menstrual cycles. Hypothyroidism, in particular, is a common condition that can lead to secondary amenorrhea due to its effects on the hypothalamic-pituitary-ovarian axis.
- Hyperprolactinemia: Elevated prolactin levels can suppress gonadotropin-releasing hormone (GnRH) secretion, leading to decreased estrogen production and amenorrhea. This can be caused by prolactinomas, thyroid disorders, or certain medications.
- 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 Tumors: Although less common, pituitary tumors (such as prolactinomas) can cause secondary amenorrhea by disrupting the normal secretion of hormones that regulate menstrual cycles. Missing this diagnosis could lead to significant morbidity due to tumor growth and hormonal imbalances.
- Sheehan Syndrome: This rare but potentially life-threatening condition occurs when the pituitary gland is damaged, usually due to severe blood loss during childbirth, leading to hypopituitarism and subsequent amenorrhea.
- Asherman Syndrome: This condition, characterized by the formation of adhesions in the uterus, can cause secondary amenorrhea. It often results from uterine surgery, such as a dilation and curettage (D&C), and can lead to significant reproductive and obstetric complications if not addressed.
Rare Diagnoses
- Congenital Adrenal Hyperplasia (CAH): A group of inherited disorders that affect the adrenal glands, leading to hormone imbalances. Some forms of CAH can cause secondary amenorrhea due to the excessive production of androgens.
- 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.