Medical Terminology for Recurrent Amenorrhea Following Pregnancy Termination
The medical term for this clinical scenario is secondary amenorrhea (cessation of previously established menstruation for longer than 6 months), which has recurred following an induced abortion or pregnancy termination 1, 2.
Specific Clinical Context
This patient has experienced post-abortion amenorrhea, which represents a specific subset of secondary amenorrhea that develops after pregnancy termination 2, 3. The complete clinical sequence includes:
- Initial secondary amenorrhea (absence of menses before the pregnancy) 1
- Pregnancy (which temporarily resolved the amenorrheic state)
- Induced abortion/pregnancy termination (completion abortion as stated)
- Recurrent secondary amenorrhea (return of absent menses post-procedure) 2, 3
Critical Diagnostic Considerations
Post-abortion amenorrhea requires immediate evaluation to distinguish between:
Intrauterine Adhesions (Asherman Syndrome)
- This is a critical complication following uterine instrumentation that can cause secondary amenorrhea through mechanical outflow obstruction 2, 4
- Requires pelvic ultrasound to assess endometrial thickness and uterine cavity 1
- May require hysteroscopy for definitive diagnosis if suspected 4
Recurrence of Original Amenorrhea Etiology
- The underlying cause of the initial amenorrhea (before pregnancy) has likely recurred 2, 3
- Pregnancy temporarily bypassed the hypothalamic-pituitary-ovarian axis dysfunction 5
- Most common etiologies include functional hypothalamic amenorrhea (FHA), polycystic ovary syndrome (PCOS), hyperprolactinemia, or primary ovarian insufficiency 1, 6
Mandatory Initial Workup
First-line laboratory evaluation must include 1, 6:
- Serum FSH, LH, prolactin, and TSH levels
- Pregnancy test (to exclude retained pregnancy or new conception)
- Pelvic ultrasound to evaluate endometrial thickness and rule out intrauterine adhesions 1
The LH/FSH ratio provides critical diagnostic information 1, 5:
- LH/FSH ratio <1 suggests functional hypothalamic amenorrhea (seen in ~82% of FHA cases)
- LH/FSH ratio >2 strongly suggests PCOS
- Both FSH and LH elevated (>40 IU/L) indicates primary ovarian insufficiency 1
Common Pitfall to Avoid
Do not assume the amenorrhea is simply due to the abortion procedure itself 2, 3. While Asherman syndrome is a recognized complication, the recurrence of amenorrhea more likely represents return of the patient's original underlying pathology that caused the initial amenorrhea 6, 2. Both possibilities must be systematically evaluated 1, 3.