Amenorrhea: Secondary

Introduction

• Description: Secondary amenorrhea is the absence of normal menstruation in a patient with previously established cycles.

• Prevalence: Common.

• Predominant Age: Reproductive age (menarche to menopause).

• Genetics: No genetic pattern.

Etiology and Pathogenesis

• Causes: Most common—pregnancy. Other causes—end organ: Asherman syndrome, outflow obstruction; ovarian (40%): polycystic ovary syndrome (PCOS, 30%), menopause, resistant ovary (Savage) syndrome, toxin exposure, surgery, autoimmune disease; central (hypothalamic, 35%), behavioral, and others: anorexia, obesity, athletics (overtraining), drugs/medications, nutritional deprivation, psychogenic (stress); medical: adenoma, craniopharyngioma, Sheehan syndrome, tuberculosis, sarcoid, empty sella syndrome; virilizing syndromes: PCOS, adrenal hyperplasia, virilizing tumors.

• Risk Factors: Unprotected intercourse, exposure to toxins, chemotherapy, or radiation; surgery; overtraining; eating disorders; psychosocial stress.

Signs and Symptoms

• Absent menstruation—may be associated with symptoms that suggest the cause.

Diagnostic Approach