Secondary Amenorrhea

Abstract

Few things cause greater concern to a woman of reproductive age than the cessation of her regular monthly menstrual period. Between menarche and menopause the only physiologic causes of amenorrhea are pregnancy and lactation. Once pregnancy has been ruled out, the absence of menses for three or more of the previous cycle intervals should be considered pathologic. While the majority of patients with secondary amenorrhea have relatively simple problems that can be easily diagnosed and managed, the physician must be concerned with potential diseases and disorders that may have more serious consequences for the patient. Amenorrhea is a symptom and not a diagnosis in itself. Non-physiologic amenorrhea is estimated to occur in 5% of women of reproductive age. In two-thirds of women menses occur at intervals of 28 ±3 days, with a normal range of 18 to 40 days.¹ Oligomenorrhea of greater, than 40 days should be treated with the same significance as secondary amenorrhea; it indicates failure of the hypothalamic-pituitary-ovarian axis to induce cyclic changes in the endometrium that normally result in regular menses. Amenorrhea may also result from failure of the end organ (endometrium) to respond or from obstruction of the outflow tract.