Introduction
A complex hormonal system influences the menstrual cycle. Hormones prepare the body for pregnancy each month. Ovulation then occurs. The cycle concludes with the uterus shedding its lining if there is no pregnancy. It sheds during the menstrual cycle. Different parts of the body produce the hormones that control this cycle. A person may not get their period if any of the following are dysfunctional:
-
The hypothalamus regulates the pituitary gland.
-
The master gland, or pituitary, is responsible for making the hormones that tell the ovaries when to ovulate.
-
Ovaries produce estrogen and progesterone, and the egg is needed for ovulation.
-
The uterus reacts to the hormones and gets the lining ready. If there is no pregnancy, this lining sheds during the menstrual period.
Amenorrhea is divided into two categories:
-
Primary amenorrhea happens when a woman has not experienced her first period by age 15 or within five years of the onset of puberty. Changes in menstrual-related organs, glands, and hormones may cause it.
-
Secondary amenorrhea occurs when one has regular periods but stops for at least three months or stops the menses for six months if they were previously irregular. Pregnancy, stress, and illness are examples of potential causes.
What Is Secondary Amenorrhea?
Secondary amenorrhea is when a person has at least one menstrual period and then stops menstruating for three months or more. Primary amenorrhea and secondary amenorrhea are two distinct conditions. It typically happens if one has not experienced the first period by age 16. This condition may be influenced by several factors, including:
-
Use of birth control.
-
Certain drugs used to treat schizophrenia, psychosis, or cancer.
-
Hormone shots.
-
Health issues like hypothyroidism.
-
Overweight or underweight.
Secondary amenorrhea typically has no negative impacts on health. In the majority of cases, it is curable. But to prevent complications, one must treat the underlying causes of amenorrhea.
What Causes Secondary Amenorrhea?
Several conditions can affect the menstrual cycle, such as anovulation, pregnancy, obstructions of the reproductive tract, and estrogen deficiency can result in secondary amenorrhea. Additionally, some lifestyle choices may make secondary amenorrhea more likely.
-
Pregnancy
Since menses is absent in pregnant women, pregnancy is among the most common causes of secondary amenorrhea. Therefore, every woman of childbearing age who exhibits secondary amenorrhea must have the possibility of pregnancy routinely investigated.
-
Anovulation
Anovulation is the absence of ovulation or the inability to release an egg during the menstrual cycle. This causes an imbalance in the hormones estrogen and progesterone, which prevents the endometrium from thickening and shedding as it usually would during menstruation. Anovulation can be brought on by several conditions, such as hypothyroidism, which is characterized by low levels of thyroid hormones; polycystic ovary syndrome (PCOS), which causes the ovaries to enlarge and have small cysts; and hyperprolactinemia, which is characterized by high levels of prolactin and may be brought on by a pituitary tumor. Anovulation may also be caused by some drugs, including antidepressants. Notably, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) release are decreased by hormonal birth control pills, which prevent ovulation. These hormonal alterations prevent the endometrium from thickening and may lead to secondary amenorrhea.
-
Estrogen Deficiency
Secondary amenorrhea can also be caused by estrogen deficiency. The endometrium will become atrophic, or very thin, without sufficient estrogen and may not be able to shed. Perimenopause, the stage before menopause during which sex hormone levels are lesser than normal, can cause an estrogen deficiency. Additionally, premature ovarian failure, which occurs when the ovaries stop producing eggs before 40 years, can result in estrogen deficiency in a person. Estrogen production is also reduced by hypothalamic-pituitary insufficiency, which manifests as reduced levels of LH and FSH.
-
Reproductive Tract Obstruction
If there is any kind of obstruction in the reproductive tract, menses typically cannot occur. One of the main causes of flow obstruction is stenosis or narrowing of the lower reproductive system. In the same way, adhesions, or fibrous tissue in the cervix or uterus, can lead to Asherman syndrome and obstruction of the menstrual flow. The symptoms of this syndrome typically appear after a procedure called dilation and curettage, wherein the cervix is dilated, and the endometrium is scraped with a spoon-shaped tool to remove any extra tissue that may still be present in the uterus.
-
Lifestyle
Any significant changes in lifestyle can affect hormone levels, which can cause secondary amenorrhea. Menstruation delays can be caused by severe eating disorders, excessive stress, or intense athletic training.
What Are the Signs and Symptoms of Secondary Amenorrhea?
The underlying cause of secondary amenorrhea typically affects the signs and symptoms of the condition. Early symptoms of secondary amenorrhea frequently include nausea, exhaustion, and breast tenderness. PCOS is frequently characterized by excessive hair growth (hirsutism), weight gain, acne, and trouble getting pregnant. People with hypothyroidism may experience fatigue, dryness, hair loss, flaky skin, and changes in the shape, color, and growth of their nails. Hypothyroidism can also cause palpitations or heartbeats that suddenly become more noticeable. Symptoms of hyperprolactinemia include blurred vision, headaches, and milky nipple discharge (galactorrhea). Usually, mood swings, hot flashes, and bone thinning accompany estrogen deficiency. Finally, abdominal pain is a usual symptom of reproductive tract obstruction.
Can Secondary Amenorrhea Cause Infertility?
Although secondary amenorrhea itself cannot result in infertility, but it can occur due to the underlying causes. Every cause of anovulation impacts a person's capacity to become pregnant. Fertilization is unlikely to happen naturally if the ovaries do not release eggs or only occasionally release eggs. In addition, since the remaining scar tissue might prevent the fetus from implanting into the uterus, adhesions between the uterine walls could complicate pregnancies. A suggested course of action may be assisted reproductive therapy if the root causes cannot be resolved.
How Is Secondary Amenorrhea Diagnosed?
-
A physical examination and analyzing the patient's medical history serve as the basis for the diagnosis. The history must include a complete menstrual history, along with the most recent period date and overall menstrual pattern. The use of any type of contraception should also be mentioned. The doctor will examine and evaluate any associated symptoms and signs.
-
To determine the potential cause, additional diagnostic tests, such as blood and urine tests, are typically advised. Always perform a β-hCG test to rule out pregnancy. By determining the levels of thyroid-stimulating hormones, hypothyroidism should be ruled out if the β-hCG test is negative. Then, it's common practice to assess the levels of sex hormones like FSH, LH, estrogen, and progesterone.
-
Prolactin levels may also be determined if hyperprolactinemia is suspected. Additional diagnostic procedures, such as computed tomography (CT) scan or magnetic resonance imaging (MRI), may be carried out to determine whether a pituitary tumor is present.
How Is Secondary Amenorrhea Treated?
It is critical to identify and treat the underlying reason behind secondary amenorrhea in order to treat it. Progesterone-containing or combined oral contraceptive pills (estrogen and progesterone) are used to treat most PCOS cases in order to control the menstrual cycle. Thyroid hormones are frequently prescribed for hypothyroidism, which quickens the return of menstruation. In the meantime, pituitary tumor removal or dopamine agonists are used to treat hyperprolactinemia. Hormone replacement therapy is used to treat ovarian failure, depending on the patient's age, symptoms, and other risk factors. Hysteroscopic surgery is used to treat Asherman syndrome and cervical stenosis.
Conclusion
The absence of regular menstrual periods for three months or longer, or irregular periods for six months or longer, is secondary amenorrhea. Numerous conditions, including pregnancy, anovulation, estrogen deficiency, obstructions of the reproductive tract, and significant lifestyle changes, can result in secondary amenorrhea. Depending on the condition's underlying cause, a person with secondary amenorrhea may experience various symptoms. Some underlying issues are frequently linked to infertility and assisted reproductive therapy may be advised. A thorough medical history review, physical examination, blood tests, and occasionally imaging are required to diagnose secondary amenorrhea. The underlying cause will determine the course of treatment.
