Secondary Amenorrhoea

Question 1

Define SA

Answer 1

absence of menstruation for six months or longer in a woman who has previously had regular menstrual cycles.

Question 2

What are potential causes of SA

Answer 2

Pregnancy (most common cause)
Breastfeeding
Menopause
Intrauterine adhesions leading to outflow tract obstruction (Asherman’s syndrome)
Polycystic ovary syndrome (PCOS)
Drug-induced amenorrhoea (e.g. contraceptive use)
Physical stress, excess exercise, and weight loss
Pituitary gland pathology, such as Sheehan syndrome or hyperprolactinaemia
Hypothyroidism or hyperthyroidism

Question 3

What are additional symptoms of SA?

Answer 3

Pregnancy symptoms: nausea, breast tenderness, increased urination, food cravings or aversions
Menopause symptoms: hot flashes, night sweats, sleep problems, mood changes
Symptoms of PCOS: acne, weight gain, hirsutism (excessive body hair), thinning hair
Symptoms of pituitary gland issues: headaches, vision problems, unexplained weight gain or loss

Question 4

What are differentials for SA?

Answer 4

Pregnancy: confirmed by a positive pregnancy test, ultrasound, and physical examination

Menopause: diagnosed based on age, symptoms such as hot flashes and night sweats, and elevated FSH levels

PCOS: diagnosed based on irregular periods, signs of high testosterone levels (acne, hirsutism), and presence of numerous small cysts on the ovaries

Asherman’s Syndrome: diagnosed based on history of uterine surgery and confirmed by hysteroscopy

Question 5

What are investigations?

Answer 5

Pregnancy test
Hormone level checks, including FSH, LH, TSH, prolactin, and testosterone
Ultrasound or other imaging studies, to identify potential structural abnormalities
Hysteroscopy, in cases where intrauterine adhesions are suspected

Question 6

How is SA managed?

Answer 6

For pregnancy: regular prenatal care

For menopause: hormone replacement therapy (HRT) if symptoms are troublesome

For PCOS: lifestyle changes, hormonal contraceptives, and potentially metformin

For Asherman’s syndrome: surgical removal of adhesions and hormone therapy

For drug-induced amenorrhoea: discontinuing the offending drug if possible and safe to do so

For conditions related to physical stress, weight loss, or excessive exercise: lifestyle modifications and nutritional counselling.