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A.D.A.M. Medical Encyclopedia [Internet]. Atlanta (GA): A.D.A.M.; 2013.

A.D.A.M. Medical Encyclopedia.

Secondary amenorrhea

Amenorrhea - secondary; No periods - secondary; Absent periods - secondary; Absent menses - secondary; Absence of periods - secondary

Last reviewed: May 31, 2012.

Secondary amenorrhea occurs when a woman who has been having normal menstrual cycles stops getting her periods for 6 or more months.

Women who are pregnant, breastfeeding, or in menopause are not considered to have secondary amenorrhea.

Causes, incidence, and risk factors

Women who are taking birth control pills or who receive hormone shots such as Depo-Provera may not have any monthly bleeding. When they stop taking these hormones, their periods may not return for more than 6 months.

You are more likely to have amenorrhea if you:

  • Are obese
  • Exercise too much and for long periods of time
  • Have very low body fat (less than 15% - 17%)
  • Have severe anxiety or emotional distress
  • Lose a lot of weight suddenly (such as with strict or extreme diets or after gastric bypass surgery)

Other causes include:

Also, procedures such as a dilation and curettage (D and C) can lead to scar tissue formation that may cause a woman to stop menstruating. This is called Asherman syndrome. Scarring may also be caused by some severe pelvic infections.

Symptoms

In addition to having no menstrual periods, other symptoms can include:

If amenorrhea is caused by a pituitary tumor, there may be other symptoms related to the tumor, such as vision loss and headache.

Signs and tests

A physical exam and pelvic exam must be done to check for pregnancy. A pregnancy test will be done.

Blood tests may be done to check hormone levels, including:

Other tests that may be performed include:

Treatment

Treatment depends on the cause of the amenorrhea. Normal monthly periods usually return after the condition is treated.

A lack of menstrual period due to obesity, vigorous exercise, or weight loss may respond to a change in exercise routine or weight control.

Expectations (prognosis)

The outlook depends on the cause of amenorrhea. Many of the conditions that cause secondary amenorrhea will respond to treatment.

Calling your health care provider

Call for an appointment with your primary health care provider or women's health provider if you have missed more than one period so that you can get diagnosed and treated, if necessary.

References

  1. Lobo RA. Primary and secondary amenorrhea and precocious puberty: etiology, diagnostic evaluation, management. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Mosby Elsevier; 2012:chap 38.
  2. Bulun SE. The physiology and pathology of the female reproductive axis. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 17.

Review Date: 5/31/2012.

Reviewed by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington; and Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.

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The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org). URAC's accreditation program is an independent audit to verify that A.D.A.M. follows rigorous standards of quality and accountability. A.D.A.M. is among the first to achieve this important distinction for online health information and services. Learn more about A.D.A.M.'s editorial policy, editorial process and privacy policy. A.D.A.M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health on the Net Foundation (www.hon.ch).

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only — they do not constitute endorsementscof those other sites. © 1997–2011 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Copyright © 2013, A.D.A.M., Inc.

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    Women with polycystic ovary syndrome (PCOS) typically have infrequent or absent periods and increased hair growth and acne. Women with PCOS are also at risk of developing metabolic syndrome, such as diabetes, high blood pressure and high cholesterol levels. High insulin levels are thought to play a role in PCOS and are generally worse with obesity. Insulin‐sensitising drugs considered in this review are metformin, rosiglitazone, pioglitazone and D‐chiro‐inositol. This updated review showed that the use of medications to lower insulin levels, such as metformin either alone or in combination with drugs to induce ovulation (for example clomiphene citrate), does not increase the chance of having a live birth. Metformin was also associated with increased gastrointestinal symptoms such as nausea and diarrhoea.
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Figures

  • Secondary amenorrhea.
    Normal uterine anatomy (cut section).

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