Secondary Amenorrhea

Secondary amenorrhea is the absence of menstrual bleeding in a woman who
has been menstruating normally but later stops menstruating for 3 or
more months.

Furthermore, there must be none of the known physiologic or drug-induced causes of amenorrhea.

This is obviously the most common form of amenorrhea and pregnancy is top ranking in this list!

Physiologic Causes

There are 4 normal states that cause secondary absence of
menstruation. In other words, medical evaluation and treatment are
not needed in such cases.

These states are

1. Pregnancy. The usual first sign is absence of menses.
2. Breastfeeding.
   The process of breast feeding usually arrests menstrual flow. The
   breasts tell the uterus that there is still a young baby so no
   conception now! This is called lactational amenorrhea (lactational means
   breastfeeding).
3. Menopause. This is the normal period of cessation of menses. No worries of amenorrhea after menopause!
4. Birth
   control medications. They may be pills or injections containing the
   hormones which affect the menstrual cycle. Some may lead to an absence
   of menstruation.

Other Causes

As discussed under causes of amenorrhea,these
causes are usually grouped under those that affect the hormonal axis(
hypothalamus-pituitary gland-ovaries) and those that affect the genital
organs(uterus-vagina) .

Amongst these causes of amenorrhea are those collectively called functional causes.
They are functional because they are due to functional perturbations
without any organic abnormality in any of the structures.

These are

• Excessive exercise especially amongst high level athletes
• Excessive stress. The cycle is sensitive to stress.
• Excessive weight gain or weight loss
• Malnutrition: Feeding habits could therefore have a bearing on the menstrual cycle.
• Eating disorders: Anorexia nervosa or bulimia
• Chronic diseases like tuberculosis and HIV.
• Psychiatric disorders like depression.
• Recreational drug use
• Drugs used in the treatment of psychiatric drugs. They are called psychotropic drugs.

More causes including polycystic ovarian disease, autoimmune disease and tumours are presented under causes of amenorrhea.

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