What Is Secondary Amenorrhea?

Secondary amenorrhea refers to a woman who has had regular menstrual cramps but has stopped menstruation for more than 6 months due to some reason, or stopped for more than 3 cycles based on her original menstrual cycle. After the occurrence of secondary amenorrhea, you should go to the hospital for examination in time.

Basic Information

English name: Secondary Amenorrhea
Visiting department: Gynecology
Common causes: Mental stress, weight loss, drugs, craniopharyngioma, pituitary infarction, pituitary tumor, empty saddle syndrome, premature ovarian failure, functional ovarian tumors, etc.

Common symptoms: Had regular menstruation, menopause for more than 6 months for some reason, with symptoms of primary disease

Causes of secondary amenorrhea

Hypothalamic amenorrhea

Most common, including mental stress (sudden or prolonged mental depression, tension, depression, environmental changes, overwork, etc.), weight loss (excessive dieting, sharp weight loss), long-term strenuous exercise, drugs (long-term steroidal contraceptives ), Craniopharyngioma.

2. Pituitary amenorrhea

Pituitary infarction, pituitary tumor, empty saddle syndrome.

3. Ovarian amenorrhea

Premature ovarian failure, functional ovarian tumors, polycystic ovary syndrome.

4. Uterine amenorrhea

Asherman syndrome, puerperal infection, endometrial tuberculosis infection, and infections caused by various hysteroscopic procedures, hysterectomy, hysterectomy or radiotherapy.

5. Abnormal endocrine function of thyroid, adrenal gland, pancreas, etc.

Clinical manifestations of secondary amenorrhea

Those who have had regular menstrual cramps but have stopped menstruation for more than 6 months due to some reason. May be accompanied by symptoms of primary disease.

Secondary amenorrhea

Whole body examination

Pay attention to general development and nutritional status, mental status, intelligence level, physical deformity, if necessary, measure height, weight and check the development of secondary sexual characteristics, such as obesity, hairy, and galactorrhea.

2. Gynecological examination

Pay attention to the development of the vulva, whether the clitoris is enlarged, whether the vaginal development is normal, whether the vagina is obstructed, deformed, atrophied, and whether the ovaries are enlarged.

3. Uterine examination

(1) Hysteroscopy: Accurate diagnosis of intrauterine adhesions.

(2) Laparoscopy: the ovarian shape and uterine size can be observed directly.

(3) Uterine fallopian tube angiography: To know whether there are uterine lesions and uterine adhesions.

(4) Pelvic B-ultrasound: Understand uterine size and ovarian condition.

(5) Drug tests: Including sequential tests of progesterone and estrogen and progesterone and pituitary excitability test.

4. Ovarian function test

(1) Basal body temperature measurement: understand whether ovulation and corpus luteum function.

(2) Determination of estrogen and progesterone levels: understand ovarian function.

5. Pituitary function test

(1) Determination of FSH and LH in blood

(2) Pituitary excitement test

(3) Determination of prolactin (PRL) in blood

(4) X-ray film of the saddle, magnetic resonance examination, etc .: to exclude pituitary tumors.

6.Chromosome inspection

Except sexual dysplasia.

Secondary amenorrhea diagnosis

Diagnosis is based on medical history, physical examination, clinical manifestations and related auxiliary examinations, hormone determination, etc.

Secondary amenorrhea treatment

Cause treatment

Find and treat the organic disease that causes amenorrhea. For example, tuberculous endometritis is given anti-diarrheal treatment. Patients with intrauterine adhesions should dilate the uterine cavity and place a birth control ring to prevent re-adhesion. After the diagnosis of the pituitary or ovarian tumor is clear, the treatment plan is determined according to the location, size, and nature of the tumor, and surgery, radiotherapy, chemotherapy or other comprehensive measures are selected.

2. Hormone therapy

After clarifying the path of the disease and its cause, the corresponding hormone therapy is given to supplement the hormone deficiency in the body or antagonize it. General application of sex hormone artificial cycle therapy. After the application of sex hormones, menstrual-like periodic withdrawal of bleeding occurs, on the one hand, the physiological and psychological state of the patient is corrected, and the secondary sexual characteristics and menstruation of the patient are promoted and maintained.

(1) Estrogen supplement therapy: suitable for those without uterus.

(2) estrogen and progestin artificial cycle method: applicable to those with uterus.

(3) Progestin therapy: It is suitable for those with a degree of amenorrhea who have a certain level of estrogen in the body.

3. Induced ovulation

If ovarian function has not failed and fertility is required, hormones or their analogs can be used to induce ovulation.

(1) Clomiphene: It is suitable for anovulators who have a certain level of estrogen in the body.

(2) Gonadotropin: Follicle stimulating hormone (HMG) combined with chorionic gonadotropin (HCG) promotes follicular development and induces ovulation.

(3) GnRH: suitable for hypomenal amenorrhea.

4. Bromocriptine

Suitable for amenorrhea amenorrhea syndrome and pituitary prolactinoma.

Some patients can recover naturally after physical or mental adjustments or discontinuation of contraceptives, and some patients can resume menstruation after progesterone, artificial cycles and ovulation promotion.