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

Ladies are inclined to get their first interval quickly after noticing puberty indicators reminiscent of the event of breasts, and development of pubic hair. You in all probability had it if you have been 12 years outdated although it will possibly begin earlier than or after that. Following your first interval, you should be getting common menstrual cycles. However not all ladies get common intervals all through their reproductive stage. Generally, ladies who’re already menstruating don’t get their interval for 3 months or extra. That’s known as secondary amenorrhea, which can must do with being pregnant or different elements reminiscent of diabetes and modifications in physique weight.

What’s secondary amenorrhea?

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

It’s not a situation itself, however relatively a symptom of an underlying well being downside that could be linked to hormonal, structural, or lifestyle-related elements. It’s important to determine and handle the explanation behind it to handle secondary amenorrhea successfully.

What are the causes of secondary amenorrhea?

There are various causes of secondary amenorrhea. However being pregnant is the most typical trigger, in response to analysis revealed in Obstetrics and Gynecology: A Competency-Based mostly Companion in 2010. Different causes of secondary amenorrhea embody:

1. Hormonal imbalances

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

2. Life-style elements

• Excessive weight modifications: Rapidly shedding numerous weight, low physique fats, or consuming problems reminiscent of anorexia, and bulimia can result in absence of intervals. “Weight problems may have an effect on hormonal stability,” 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 attributable to surgical procedures like dilation and curettage.
• Uterine abnormalities: Fibroids, or polyps can result in absence or irregular intervals.

4. Medicines and medical remedies

• Contraceptives: Hormonal contraceptives or intrauterine gadgets could disrupt intervals. Whereas taking medicines reminiscent of hormonal contraception, it will possibly cease intervals, in response to the American Faculty of Obstetricians and Gynecologists.
• Medicines: Antipsychotics, antidepressants, and chemotherapy medication might 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 situations

• Diabetes: “Power situations like diabetes can influence hormonal regulation,” says the skilled. Throughout a 2006 examine revealed within the Human Replica journal, within the pre-pubertal diabetic group, 7 % of them had secondary amenorrhea. Researchers additionally discovered that within the post-pubertal diabetic group, 12 % of them had this kind 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 intervals for 3 months in a row, ladies might also expertise the next signs:

• Scorching flashes or evening sweats
• Vaginal dryness
• Pimples or extra facial or physique hair development
• Breast discharge
• Weight acquire 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 completely different.

• Major amenorrhea: In terms of main amenorrhea, the vast majority of instances are attributable to gonadal dysfunction, a medical situation that impacts the gonads or reproductive organs. Throughout analysis revealed in StatPearls in 2023, it was discovered that 43 % of the members with main amenorrhea had this situation. Delay of development and puberty is one other trigger.
• Secondary amenorrhea: There are hormonal, life-style, or medical situations behind it although being pregnant is the most typical trigger.

What are the remedy choices for secondary amenorrhea?

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

1. Life-style modifications

If secondary amenorrhea is because of life-style elements, the next modifications might help restore menstrual cycles:

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

2. Medical remedies

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

3. Therapy for underlying situations

• Polycystic Ovary Syndrome: Life-style modifications, insulin-sensitising medication (e.g., metformin), and hormonal remedy could assist.
• Asherman’s Syndrome: Your physician could 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 massive or unresponsive to medicine.
• 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 girls needing to get pregnant, ovulation-stimulating remedies or assisted reproductive applied sciences could also be thought-about.

Therapy plans for secondary amenorrhea ought to be made in response to the trigger. With acceptable remedy, it’s possible you’ll recuperate your menstrual cycle and stop long-term problems reminiscent of infertility or osteoporosis.