Secondary amenorrhea

Secondary amenorrhea


INTRODUCTION:

  • Secondary amenorrhea is the absence of menstrual bleeding in a woman who had been menstruating but later stops menstruating for three or more months.
ETIOLOGY: 

Physiological cause:

  • M/c cause is pregnancy.
  • Lactation
  • Menopause

Pathological causes: 

  • Sheehan’s syndrome (post-partum pituitary necrosis) 
  • Ashermann syndrome
SYMPTOMS:
  • Missing several menstrual periods in a row. 
  • Acne
  • Vaginal dryness
  • Deepening of the voice
  • Excessive or unwanted hair growth on the body
  • Headaches
  • Changes in vision
  • Nipple discharge
DIAGNOSTIC TESTS:
  • Pregnancy test
  • Hormone tests: Testosterone, estrogen, and other hormones in your blood.
  • MRI, CT scans, and ultrasound tests 
TREATMENT:
Medical Treatment:

  • Birth control pills or other types of hormonal medication.
  • Medications to help relieve the symptoms of PCOS. Clomiphene citrate (CC) therapy is often prescribed to help trigger ovulation
  • Estrogen replacement therapy (ERT). 
    • ERT may help balance hormonal levels and restart the menstrual cycle in women with primary ovarian insufficiency (POI) or Fragile X-associated primary ovarian insufficiency (FXPOI)
    • ERT replaces the estrogen a woman’s body should be making naturally for a normal menstrual cycle.
    • ERT may help women with FXPOI lower their risk for the bone disease osteoporosis.
    • ERT can increase the risk for uterine cancer, so your health care provider may also prescribe progestin or progesterone to reduce this risk.

Surgical Treatment :

Uterine scarring

  • Occurs after removal of uterine fibroids, a cesarean section, or a dilation and curettage (D&C)
  • Removal of the scar tissue during a procedure called a hysteroscopic resection can help restore the menstrual cycle.

Pituitary tumor.:

  • Medications may be recommended to shrink the tumor. 
  • If this does not work, surgery may be necessary to remove the tumor. 

Exam Important

  • In a case of secondary amenorrhea who fails to get withdrawl bleeding after taking E and P, the fault lies at the level of Endometrium
  • In secondary amenorrhea the cause could be  Stein leventhal syndrome & Premature ovarian failure
  • Commonest cause of secondary amenorrhea is Pregnancy
  • Female with secondary amenorrhea with serum prolactin level 75 ng/ml is to be treated with  Cabergoline
  • Secondary amenorrhea and galactorrhea with  tumour of < 10mm diameter in the pituitary fossa can be treated by Bromocriptine
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