Being pregnant could also be one of many explanation why you aren’t getting your intervals. However there are extra causes of secondary amenorrhea.
Ladies are likely to get their first interval quickly after noticing puberty indicators reminiscent of the event of breasts, and development of pubic hair. You in all probability had it while you had been 12 years outdated although it might probably begin earlier than or after that. Following your first interval, you should be getting common menstrual cycles. However not all girls get common intervals all through their reproductive stage. Generally, girls 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 elements reminiscent of diabetes and adjustments in physique weight.
What’s secondary amenorrhea?
Amenorrhea is the absence of intervals, and secondary amenorrhea is one among its varieties. “It refers back to the absence of intervals for 3 consecutive cycles or for six months in a girl who beforehand had common intervals,” explains obstetrician and gynaecologist Dr Chetna Jain.
It isn’t a situation itself, however quite a symptom of an underlying well being downside which may be linked to hormonal, structural, or lifestyle-related elements. It’s important to determine and handle the rationale 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 response to analysis revealed in Obstetrics and Gynecology: A Competency-Based mostly Companion in 2010. Different causes of secondary amenorrhea embody:
1. Hormonal imbalances
- Polycystic Ovary Syndrome: In girls with PCOS, disruption in ovulation occurs attributable to extra androgens. Throughout an evaluation revealed in StatPearls in October 2024, of all girls with secondary amenorrhea, about 30 to 40 p.c of them had a power anovulatory (lack of ovulation) dysfunction like PCOS.
- Thyroid issues: Hypothyroidism (underactive thyroid) or hyperthyroidism (overactive thyroid) are amongst a number of the circumstances that have an effect on interval.
- Hyperprolactinemia: Elevated ranges of prolactin (a hormone liable for lactation) inhibit ovulation.
- Untimely Ovarian Insufficiency: Early depletion of ovarian follicles results in decreased estrogen manufacturing.
2. Way of life elements
- Excessive weight adjustments: Shortly dropping numerous weight, low physique fats, or consuming issues reminiscent of anorexia, and bulimia can result in absence of intervals. “Weight problems can even have an effect on hormonal stability,” says the knowledgeable.
- 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 intervals.
4. Drugs and medical remedies
- Contraceptives: Hormonal contraceptives or intrauterine gadgets might disrupt intervals. Whereas taking medicines reminiscent of hormonal contraception, it might probably cease intervals, in response to the American School of Obstetricians and Gynecologists.
- Drugs: Antipsychotics, antidepressants, and chemotherapy medication may additionally have an effect in your menstrual cycle.
- Radiation or surgical procedure: Remedies focusing 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 knowledgeable. Throughout a 2006 research revealed within the Human Replica journal, within the pre-pubertal diabetic group, 7 p.c of them had secondary amenorrhea. Researchers additionally discovered that within the post-pubertal diabetic group, 12 p.c of them had such a 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?
Other than the absence of intervals for 3 months in a row, girls may additionally expertise the next signs:
- Scorching flashes or evening sweats
- Vaginal dryness
- Zits or extra facial or physique hair development
- Breast discharge
- Weight achieve or loss
- Lower in breast measurement
- 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 varieties are totally different.
- Main amenorrhea: On the subject of main amenorrhea, nearly all of circumstances are attributable to gonadal dysfunction, a medical situation that impacts the gonads or reproductive organs. Throughout analysis revealed in StatPearls in 2023, it was discovered that 43 p.c of the members with main amenorrhea had this situation. Delay of development and puberty is one other trigger.
- Secondary amenorrhea: There are hormonal, life-style, or medical circumstances behind it although being pregnant is the commonest trigger.
What are the therapy choices for secondary amenorrhea?
Like some other well being situation, therapy for secondary amenorrhea focuses on addressing the underlying trigger.
1. Way of life adjustments
If secondary amenorrhea is because of life-style elements, the next adjustments may help restore menstrual cycles:
- Balanced food regimen: “Right malnutrition or weight problems by adopting a wholesome consuming plan,” says the knowledgeable. Embody greens, complete grains, fruits, nuts, and seeds in your food regimen.
- Weight administration: Achieve weight if you’re underweight or improve your physique fats. Drop some weight if weight problems is a contributing issue.
- Modify train routine: Cut back extreme bodily exercise if you’re working too exhausting within the gymnasium.
2. Medical remedies
- Estrogen or progesterone dietary supplements may help to revive hormonal stability and defend towards bone loss.
- Mixed oral contraceptives will assist to control cycles and stability hormones.
- Dopamine agonists like cabergoline or bromocriptine will assist to cut back prolactin ranges.
- For fertility, medication like clomiphene citrate could also be prescribed.
3. Therapy for underlying circumstances
- Polycystic Ovary Syndrome: Way of life modifications, insulin-sensitising medication (e.g., metformin), and hormonal remedy might assist.
- Asherman’s Syndrome: Your physician might 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 medicine.
- 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 wanting to get pregnant, ovulation-stimulating remedies or assisted reproductive applied sciences could also be thought-about.
Therapy plans for secondary amenorrhea ought to be made in response to the trigger. With applicable therapy, chances are you’ll get well your menstrual cycle and stop long-term issues reminiscent of infertility or osteoporosis.
Associated FAQs
Is secondary amenorrhea harmful?
Secondary amenorrhea is just not inherently harmful, however it may be a symptom of underlying well being points that will have severe implications if left untreated. Continual anovulation (lack of ovulation) could make it troublesome to conceive, and extended absence of estrogen attributable to circumstances like untimely ovarian insufficiency or hypothalamic amenorrhea can result in low bone density or osteoporosis.
Can PCOS trigger secondary amenorrhea?
Sure, Polycystic Ovary Syndrome (PCOS) is a standard reason for secondary amenorrhea. It’s a hormonal dysfunction that stops common ovulation as a result of the ovaries fail to launch eggs frequently. With out ovulation, the menstrual cycle is disrupted, resulting in missed intervals. Elevated ranges of androgens and imbalanced estrogen and progesterone ranges intervene with the menstrual cycle.
