Secondary amenorrhea: the causes of the lack of menstruation

Missing a period for at least 4 months is called secondary amenorrhea. And when it occurs, some clinical investigations are necessary.

Usually secondary amenorrhea does not appear suddenly but follows a condition of oligomenorrhea (cycles longer than 36 days).

Excluding pregnancy which evidently suspends the cycle for nine months and beyond, a prolonged absence must take into consideration other causes which are divided into organic and dysfunctional.

The ones that occur most frequently are:

Organic causes of secondary amenorrhea

  1. Among the most common causes we find hyperandrogenism . It is a condition in which too high levels of androgens are found which can cause amenorrhea. The most common form of hyperandrogenism is PCOS.
  2. Infectious causes : Meningitis or encephalitis can damage the hypothalamus and/or pituitary and cause secondary amenorrhea
  3. Neoplasms involving the central nervous system, pituitary and hypothalamus. The most frequent are pituitary adenomas which are divided into secretory and non-secretory and micro and macro-adenomas. The most common are prolactin-secreting adenomas .
  4. Genital malformations : the most common conditions are adhesions or synechiae which more or less completely occlude the uterine cavity and/or the cervical canal. They can be and are due to Ashermann’s syndrome. Synechiae are a consequence of revisions of the uterine cavity or lacerations from childbirth or cesarean section, or adhesions due to previous genital infections.
  5. traumatic causes : which may have injured the structures of the reproductive axis (hypothalamus-pituitary-ovary)
  6. Vascular causes : This is post-infarction piphyseal necrosis, often caused by postpartum hemorrhagic shock (Sheenan syndrome). It is manifested by amenorrhea due to hypogonadotropic hypogonadism, lactotropic, corticotropic and thyrotropic function deficits.
  7.  Dysmetabolic causes: In patients who have undergone a gastrectomy or who have malabsorption due to gastro-intestinal pathologies, amenorrhea may occur due to a lack of quality and quantity of nutrients necessary for hormonal synthesis.

Dysfunctional causes of secondary amenorrhea

It is a common form of amenorrhea that mainly affects teenage girls.

The causes in this case are linked to conditions of physical, metabolic or emotional stress. It is a situation that occurs, for example, in girls who suffer from eating disorders such as anorexia. Weight loss that is too rapid or that leads to a very low body mass index can cause secondary amenorrhea. Or it can occur in those who do a lot of physical activity (marathon runners, dancers, gymnasts, etc.) and again in those who have suffered a strong mourning or are experiencing a separation or in any case an important psycho-emotional stress .

In all these cases, a detailed medical history is important in order to choose the appropriate therapy.

Kathryn Barlow is an OB/GYN doctor, which is the medical specialty that deals with the care of women's reproductive health, including pregnancy and childbirth.

Obstetricians provide care to women during pregnancy, labor, and delivery, while gynecologists focus on the health of the female reproductive system, including the ovaries, uterus, vagina, and breasts. OB/GYN doctors are trained to provide medical and surgical care for a wide range of conditions related to women's reproductive health.

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