Secondary amenorrhea: Know what causes the absence of three or more menstrual cycles

Ladies are likely to get their first interval quickly after noticing puberty indicators similar to the event of breasts, and development of pubic hair. You most likely had it whenever you had been 12 years previous although it may possibly begin earlier than or after that. Following your first interval, you should be getting common menstrual cycles. However not all ladies get common durations all through their reproductive stage. Generally, ladies who’re already menstruating don’t get their interval for 3 months or extra. That’s referred to as secondary amenorrhea, which can must do with being pregnant or different components similar to diabetes and adjustments in physique weight.

What’s secondary amenorrhea?

Amenorrhea is the absence of durations, and secondary amenorrhea is one in all its varieties. “It refers back to the absence of durations for 3 consecutive cycles or for six months in a girl who beforehand had common durations,” explains obstetrician and gynaecologist Dr Chetna Jain.

It isn’t a situation itself, however quite a symptom of an underlying well being drawback that could be related to hormonal, structural, or lifestyle-related components. It’s important to establish and deal with the explanation behind it to handle secondary amenorrhea successfully.

What are the causes of secondary amenorrhea?

There are lots of causes of secondary amenorrhea. However being pregnant is the most typical trigger, in accordance with analysis revealed in Obstetrics and Gynecology: A Competency-Primarily based Companion in 2010. Different causes of secondary amenorrhea embody:

1. Hormonal imbalances

• Polycystic Ovary Syndrome: In ladies with PCOS, disruption in ovulation occurs resulting from extra androgens. Throughout an evaluation revealed in StatPearls in October 2024, of all ladies with secondary amenorrhea, about 30 to 40 p.c of them had a power anovulatory (lack of ovulation) dysfunction like PCOS.
• Thyroid issues: Hypothyroidism (underactive thyroid) or hyperthyroidism (overactive thyroid) are amongst a number of the circumstances that have an effect on interval.
• Hyperprolactinemia: Elevated ranges of prolactin (a hormone chargeable for lactation) inhibit ovulation.
• Untimely Ovarian Insufficiency: Early depletion of ovarian follicles results in decreased estrogen manufacturing.

2. Way of life components

• Excessive weight adjustments: Rapidly dropping lots of weight, low physique fats, or consuming issues similar to anorexia, and bulimia can result in absence of durations. “Weight problems can even have an effect on hormonal steadiness,” says the skilled.
• Extreme train: Intense bodily exercise can suppress ovulation.
• Stress: Psychological or bodily stress can disrupt the hypothalamic-pituitary-ovarian axis, which is a significant regulator of the feminine reproductive system.

3. Reproductive system points

• Asherman’s Syndrome: It’s a situation that results in uterine scarring, usually resulting from surgical procedures like dilation and curettage.
• Uterine abnormalities: Fibroids, or polyps can result in absence or irregular durations.

4. Drugs and medical therapies

• Contraceptives: Hormonal contraceptives or intrauterine units might disrupt durations. Whereas taking drugs similar to hormonal contraception, it may possibly cease durations, in accordance with the American Faculty of Obstetricians and Gynecologists.
• Drugs: Antipsychotics, antidepressants, and chemotherapy medicine can also have an effect in your menstrual cycle.
• Radiation or surgical procedure: Therapies concentrating on the pelvic space or mind can have an effect on reproductive hormones.

5. Power medical circumstances

• Diabetes: “Power circumstances like diabetes can affect hormonal regulation,” says the skilled. Throughout a 2006 examine revealed within the Human Copy journal, within the pre-pubertal diabetic group, 7 p.c of them had secondary amenorrhea. Researchers additionally discovered that within the post-pubertal diabetic group, 12 p.c of them had the sort of amenorrhea.
• Pituitary tumors: These are noncancerous growths within the pituitary gland that may have an effect on hormone manufacturing.

What are the signs of secondary amenorrhea?

Aside from the absence of durations for 3 months in a row, ladies can also expertise the next signs:

• Scorching flashes or evening sweats
• Vaginal dryness
• Pimples or extra facial or physique hair development
• Breast discharge
• Weight achieve or loss
• Lower in breast measurement
• Pelvic ache
• Infertility
• Osteoporosis
• Fatigue
• Hair thinning

What’s the distinction between main and secondary amenorrhea?

“The primary distinction is that in main amenorrhea, menstruation by no means begins. Within the case of the secondary one, it happens after menstrual cycles have already begun,” says Dr Jain.

Even the causes of those two varieties are totally different.

• Main amenorrhea: With regards to main amenorrhea, nearly all of circumstances are resulting from gonadal dysfunction, a medical situation that impacts the gonads or reproductive organs. Throughout analysis revealed in StatPearls in 2023, it was discovered that 43 p.c of the members with main amenorrhea had this situation. Delay of development and puberty is one other trigger.
• Secondary amenorrhea: There are hormonal, way of life, or medical circumstances behind it although being pregnant is the most typical trigger.

What are the therapy choices for secondary amenorrhea?

Like every other well being situation, therapy for secondary amenorrhea focuses on addressing the underlying trigger.

1. Way of life adjustments

If secondary amenorrhea is because of way of life components, the next adjustments may help restore menstrual cycles:

• Balanced weight loss program: “Appropriate malnutrition or weight problems by adopting a wholesome consuming plan,” says the skilled. Embody greens, entire grains, fruits, nuts, and seeds in your weight loss program.
• Weight administration: Achieve weight in case you are underweight or improve your physique fats. Shed some pounds if weight problems is a contributing issue.
• Modify train routine: Cut back extreme bodily exercise in case you are working too arduous within the fitness center.

2. Medical therapies

• Estrogen or progesterone dietary supplements may help to revive hormonal steadiness and shield in opposition to bone loss.
• Mixed oral contraceptives will assist to manage cycles and steadiness hormones.
• Dopamine agonists like cabergoline or bromocriptine will assist to cut back prolactin ranges.
• For fertility, medicine like clomiphene citrate could also be prescribed.

3. Remedy for underlying circumstances

• Polycystic Ovary Syndrome: Way of life modifications, insulin-sensitising medicine (e.g., metformin), and hormonal remedy might assist.
• Asherman’s Syndrome: Your physician might counsel you endure surgical procedure (hysteroscopy) to take away uterine adhesions.

4. Surgical interventions

• Pituitary tumors: Surgical procedure or radiation remedy if the tumour is giant or unresponsive to treatment.
• Uterine abnormalities: Surgical procedure for structural points like fibroids or polyps.

5. Supportive therapies

• Calcium and vitamin D supplementation could also be given if low estrogen ranges are affecting bone density.
• For ladies wanting to get pregnant, ovulation-stimulating therapies or assisted reproductive applied sciences could also be thought-about.

Remedy plans for secondary amenorrhea ought to be made in accordance with the trigger. With acceptable therapy, you could get well your menstrual cycle and stop long-term problems similar to infertility or osteoporosis.