Secondary Amenorrhea

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Presentation :

• Defined as absence of menses for more than 3 months in women who previously had regular menstrual cycles or 6 months in women who have irregular menses

Pathophysiology :

• Etiologies include:
  • Pregnancy
  • Hypogonadotrophic hypogonadism
    • hypothyroidism
    • hyperprolactinemia
    • hypothalamic (stress, weight loss, exercise)
    • pituitary (tumor, Sheehan syndrome)
  • Premature ovarian insufficiency (autoimmune)
  • Chemotherapy or pelvic radiation

Diagnostic Testing:

• Pregnancy test
• In the absence of pregnancy, assess hormonal status with estradiol, FSH, LH, TSH, and prolactin levels.
  • Low estradiol and low or inappropriately normal FSH and LH indicate hypogonadotrophic hypogonadism
    • Perform progesterone challenge test:
      • Withdrawal bleeding indicates

Treatment :

• Treat the underlying disorder
• Prevent osteoporosis by choosing estrogen and progesterone replacement until menstruation returns to normal or age ~50 years

Prognosis:

References: