Amenorrhea – Secondary

Secondary amenorrhea is the absence of menses for 6 months in a woman with previously regular menstrual cycles, or 12 months in a woman whose periods had been irregular.

Differential Diagnosis

• Pregnancy
  –Most common cause
• Anovulatory cycles
  –Common during first few years after menarche
  • Hyperandrogenism
    –Polycystic ovary syndrome: Problems with fertility are common, LH/FSH ratio is greater than 2.5/1
    –Some adrenal tumors
    –Congenital adrenal hyperplasia
    –Exposure to anabolic steroids
  • Major illness or stress
  • Large changes in weight
    –Anorexia nervosa
  • Hypothyroidism
  • Prolactinoma
  • Other causes of hyperprolactinemia
    –Marijuana
    –Opioids
    –Antidepressants
    –Phenothiazines
  • Hypothalamic-pituitary failure
    –Pituitary tumor
    –Sheehan syndrome
    –Cranial irradiation
  • Ovarian failure
    –Autoimmune destruction
    –Infarction due to gonadal torsion
    –Chemotherapy or radiation
    –Idiopathic
  • Oral contraceptives
    –May delay return to regular menses
  • Cushing syndrome
  • Uterine synechiae (Asherman syndrome)
  • Chiari-Frommel syndrome

  Workup and Diagnosis

  • History
    –Major illness, thyroid disease, malnutrition, eating disorder, excessive weight gain or loss
    –Intensive exercise
    –Previous uterine procedures
    –Prior pregnancy with failure of lactation
    –Sexual activity
  • Review of systems
    –Virilization (e.g. facial hair, acne)
    –Symptoms of hypothyroidism
    –Headache or visual changes (for intracranial tumors)
    –Breast discharge, decreased breast size
  • Physical exam
    –Height, weight, acne, facial hair, acanthosis nigricans, striae, galactorrhea
    –Visual fields and optic discs (for intracranial tumors)
    –Palpate thyroid for goiter
    –Underestrogenized vaginal mucosa is reddish, thin, and atrophic
    • Labs
      –Pregnancy test
      –Thyroid function tests, FSH, LH, estradiol, prolactin, total and free testosterone, dehydroepiandrostenedione sulfate (DHEA-s), 17-hydroxyprogesterone
      –3-day progesterone “challenge” that induces withdrawal bleeding suggests adequate estrogen
    • MRI of the brain/pituitary to evaluate for pituitary pathology

    Treatment

    • Correction of systemic illness, malnutrition, eating disorder, or other stress
    • Hyperprolactinemia
      –Prolactinoma: Treat with dopamine agonist
      –Medication-induced: Cessation of the offending agent
    • Polycystic ovary syndrome
      –Weight loss
      –Oral contraceptives
      –Antiandrogen agents such as spironolactone
      –Insulin sensitizers such as metformin
    • Ovarian failure
      –Treat with estrogen-progestin replacement
    • Asherman syndrome
      –Treat by surgical excision of adhesions

Book Source Details

• Book Title: In A Page: Pediatric Signs and Symptoms
• Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
• Year of Publication: 2007
• Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Menstrual irregularities

Read excerpts from these other book chapters related to Menstrual irregularities:

Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

More About Causes of Menstrual irregularities

• Back to symptom: Menstrual irregularities: Introduction (review 369 causes)
• Next Book Extract About Menstrual irregularities: Amenorrhea – Primary (In A Page: Pediatric Signs and Symptoms)
• All Book Extracts: All Online Book Extracts for Menstrual irregularities

More About This Book: Title: In A Page: Pediatric Signs and Symptoms Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-4051-0427-9

 » Next page: Amenorrhea – Primary (In A Page: Pediatric Signs and Symptoms)

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• Amenorrhea (Handbook of Signs & Symptoms (Third Edition))
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