Secondary amenorrhea is the absence of periods for more than 3 months in a woman who was previously well menstruated. Causes, assessment, treatment, risk of pregnancy…
Secondary amenorrhea is absence of periods for more than 3 months in a previously well-regulated woman. It can be caused by a uterine abnormality or ovary, a early menopausea disorder of hormonal origin (often pituitary) eating disorders (anorexia nervosa), stress, incorrect dosage of a contraceptive pill, the practice of a sport at a high level.
What is secondary amenorrhea?
Secondary amenorrhea refers to theabsence of periods for more than 3 months in a woman of menstruating age. The first cause of secondary amenorrhea is pregnancy. Apart from this case, it may concern up to 5% of women.
What causes secondary amenorrhea?
► The first cause of secondary amenorrhea is the pregnancy.
► Uterine causes:
- ITo scar stenosis cervix
- Uterine adhesions
- THE hormonal IUD
- History of uterine surgery
- History of conization.
► Ovarian causes
- Early ovarian failure
- Early menopause occurring before age 40.
- endometrial atrophy
- A weak presence of ovarian follicles.
► Polycystic ovary syndrome or Stein-Leventhal syndrome, linked to an increase in volume of the ovaries linked to the presence of several small cysts, is caused by a hormonal imbalance. It causes irregular menstrual cycles that can lead to amenorrhea but also abdominal obesity, infertility, acne. Doctor Marc Even, gynecologist-obstetrician indicates that “this syndrome is a frequent cause of hyperandrogenism in women”, and therefore significant hair growth on the chest, stomach and face. Diagnosis is difficult because these symptoms are not always observed. The diagnosis is confirmed by the presence of large ovaries with multiple cysts on ultrasound and by an elevated blood LH level accompanied by a normal blood level of FSH.
► Pituitary causes: Decreased levels of FSH, LH, and estradiol accompanied by a negative progestogen test indicate pituitary disease. Taking medication such as neuroleptics may be involved. An MRI should be performed to rule out a tumour. A prolactin adenoma is suspected when amenorrhea is associated with galactorrhea and an increased blood level of prolactin. THE Sheehan syndrome, much rarer, corresponds to necrosis of the pituitary gland occurring after hemorrhagic shock, most often during childbirth during postpartum hemorrhage
► A cirrhosisA cancer or a tuberculosis.
► A hypothalamic cause
► The taking of a pill
► A psychogenic amenorrhea
► Amenorrhea in top athletes. In this case, amenorrhea, present in approximately 50% of high-level athletes practicing a sustained sports activity, is caused by a significant loss of fat mass.
► The presence of anorexia nervosa.
What are the symptoms of secondary amenorrhea?
“The symptom of secondary amenorrhea is interruption of menstruation beyond three monthsapart from pregnancy, lactation and menopause”, answers the gynecologist.
What assessment should be made to detect secondary amenorrhea?
After a detailed examination (lifestyle, diet, contraception…) the doctor will prescribe a blood test with hormonal assays and a pelvic ultrasound.
What are the consequences of secondary amenorrhea?
In the long term in young women, secondary amenorrhea may have an impact on bone mineralization.
What treatment to treat secondary amenorrhea?
Treatment is tailored to the cause of the amenorrhea. There is no single support that could be suitable for all cases. The treatment will be hormonal, surgical or psychological.
Can you get pregnant with secondary amenorrhea?
During amenorrhea, the ovaries do not release an egg, so you cannot theoretically get pregnant.
Thanks to Doctor Marc Even, obstetrician-gynecologist.