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 akin to the event of breasts, and progress of pubic hair. You in all probability had it whenever you have been 12 years outdated although it might probably begin earlier than or after that. Following your first interval, you have to be getting common menstrual cycles. However not all ladies get common durations all through their reproductive stage. Typically, ladies who’re already menstruating don’t get their interval for 3 months or extra. That’s known as secondary amenorrhea, which can should do with being pregnant or different components akin to diabetes and modifications in physique weight.

What’s secondary amenorrhea?

Amenorrhea is the absence of durations, and secondary amenorrhea is considered one of its sorts. “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’s not a situation itself, however slightly a symptom of an underlying well being drawback which may be related to hormonal, structural, or lifestyle-related components. It’s important to determine and deal with the explanation behind it to handle secondary amenorrhea successfully.

What are the causes of secondary amenorrhea?

There are numerous causes of secondary amenorrhea. However being pregnant is the commonest trigger, in keeping with analysis printed 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 attributable to extra androgens. Throughout an evaluation printed 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 among the circumstances that have an effect on interval.
• Hyperprolactinemia: Elevated ranges of prolactin (a hormone accountable for lactation) inhibit ovulation.
• Untimely Ovarian Insufficiency: Early depletion of ovarian follicles results in decreased estrogen manufacturing.

2. Life-style components

• Excessive weight modifications: Rapidly dropping a whole lot of weight, low physique fats, or consuming problems akin to anorexia, and bulimia can result in absence of durations. “Weight problems also can 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 attributable to surgical procedures like dilation and curettage.
• Uterine abnormalities: Fibroids, or polyps can result in absence or irregular durations.

4. Medicines and medical therapies

• Contraceptives: Hormonal contraceptives or intrauterine gadgets could disrupt durations. Whereas taking medicines akin to hormonal contraception, it might probably cease durations, in keeping with the American School of Obstetricians and Gynecologists.
• Medicines: Antipsychotics, antidepressants, and chemotherapy medicine may additionally have an effect in your menstrual cycle.
• Radiation or surgical procedure: Remedies concentrating on the pelvic space or mind can have an effect on reproductive hormones.

5. Continual medical circumstances

• Diabetes: “Continual circumstances like diabetes can impression hormonal regulation,” says the skilled. Throughout a 2006 examine printed within the Human Copy 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 one of these 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 may additionally expertise the next signs:

• Sizzling flashes or night time sweats
• Vaginal dryness
• Zits or extra facial or physique hair progress
• Breast discharge
• Weight achieve or loss
• Lower in breast dimension
• Pelvic ache
• Infertility
• Osteoporosis
• Fatigue
• Hair thinning

What’s the distinction between main and secondary amenorrhea?

“The principle 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 sorts are completely different.

• Main amenorrhea: In the case of main amenorrhea, nearly all of instances are attributable to gonadal dysfunction, a medical situation that impacts the gonads or reproductive organs. Throughout analysis printed in StatPearls in 2023, it was discovered that 43 % of the members with main amenorrhea had this situation. Delay of progress and puberty is one other trigger.
• Secondary amenorrhea: There are hormonal, way of life, or medical circumstances behind it although being pregnant is the commonest 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. Life-style modifications

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

• Balanced weight loss plan: “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 plan.
• Weight administration: Acquire weight in case you are underweight or improve your physique fats. Shed extra pounds if weight problems is a contributing issue.
• Modify train routine: Scale back extreme bodily exercise in case you are working too exhausting within the health club.

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 control cycles and steadiness hormones.
• Dopamine agonists like cabergoline or bromocriptine will assist to scale back prolactin ranges.
• For fertility, medicine like clomiphene citrate could also be prescribed.

3. Remedy for underlying circumstances

• Polycystic Ovary Syndrome: Life-style modifications, insulin-sensitising medicine (e.g., metformin), and hormonal remedy could assist.
• Asherman’s Syndrome: Your physician could recommend you bear 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 remedy.
• 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 therapies or assisted reproductive applied sciences could also be thought of.

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