Secondary amenorrhea

Nonpharmacologic therapy for amenorrhea varies depending on its underlying cause. Amenorrhea secondary to anorexia... 

Menstrual complications Amenorrhea secondary to depression of the hypothalamic-pimitary axis. Infertihty wiU result secondary to anovulation. 

Amenorrhea secondary to anemia or malnourish-ment might be treated with nutritive herbs (i.e., nettles, red clover, dong quai). 

Amenorrhea secondary to trauma or great emotional stress might be treated with nervines (i.e., chamomile, motherwort, bupleurum). 

Amenorrhea, other menstrual irregularities, development of cushingoid state, suppression of growth in children, secondary adrenocortical and pituitary unresponsive (particularly in times of stress), decreased carbohydrate tolerance, manifestation of latent diabetes mellitus, increased requirements for insulin or oral hypoglycemic agents (in diabetics)... 

For most conditions associated with primary and secondary amenorrhea, estrogen (along with a progestin to minimize the risk of endometrial hyperplasia) is provided. 

Amenorrhea traditionally is described as either primary or secondary in nature. Primary amenorrhea is the absence of menses by age 16 in the presence of normal secondary sexual development or the absence of menses by age 14 in the absence of normal secondary sexual development. Secondary amenorrhea is the absence of menses for three cycles or 6 months in a previously menstruating woman. However, in clinical practice, there is a significant amount of overlap. The initial evaluation of amenorrhea is often the same regardless of age of onset, except in unusual clinical situations.1... 

After pregnancy, the five most common causes of secondary amenorrhea, in descending order of prevalence, include 2... 

Therapeutic modalities for amenorrhea are targeted at restoring the normal menstrual cycle. The goals of treatment are to preserve bone density, prevent bone loss, and restore ovulation, thus improving fertility as desired. Amenorrhea resulting from conditions contributing to hypoestrogenism also may affect quality of life via the induction of hot flashes (premature ovarian failure), dyspareunia, and in prepubertal females, lack of secondary sexual characteristics and absence of menarche. 

Observational data illustrate a reduction in dysmenorrhea from 60% to 29% with the levonorgestrel-releasing IUD after 3 years.17 As observed with depo-medroxyprogesterone acetate, this reduction is likely secondary to the increasing incidence of amenorrhea in users of this contraceptive device. 

Alkylating agents Cyclophosphamide Myelosuppression, hemorrhagic cystitis Alopecia, stomatitis, amenorrhea, aspermia, secondary leukemias... 

Primary amenorrhea Absence of menses by age 16 in the presence of normal secondary sexual development or absence of menses by age 14 in the absence of normal secondary sexual development. 

Secondary amenorrhea Absence of menses for three cycles or 6 months in a previously menstruating woman. 

In cases of secondary amenorrhea, symptoms may include hot flushes, night sweats, fatigue, and mood changes. In primary amenorrhea, incomplete development of secondary sex characteristics may occur. 

Women with secondary amenorrhea (i.e., cessation of menses in a woman who was previously menstruating for 6 months or more) who have been estrogen deficient for 12 months or longer should also receive low-dose estrogen initially, but the dose can be increased up to maintenance levels... 

Norethindrone Secondary amenorrhea abnormal uterine bleeding endometriosis. Megestrol ... 

Secondary amenorrhea/abnormal uterine bleeding - For secondary amenorrhea and for abnormal uterine bleeding due to hormonal imbalance in the absence of organic pathology, such as fibroids or uterine cancer. 

Secondary amenorrhea - For use in secondary amenorrhea (capsules) the 4% gel is for the treatment of secondary amenorrhea, and the 8% gel is for women who have failed to respond to treatment with the 4% gel. 

Secondary amenorrhea - 5 to 10 mg/day for 5 to 10 days. A dose for inducing an optimum secretory transformation of an endometrium that has been adequately primed with estrogen is 10 mg daily for 10 days. Start therapy any time. Withdrawal bleeding usually occurs 3 to 7 days after therapy ends. 

Secondary amenorrhea - Give as a single daily dose of 400 mg in the evening for 10 days. 

Secondary amenorrhea - Administer 45 mg (4% gel) vaginally every other day up to a total of 6 doses. For women who fail to respond, a trial of 8% gel every other day up to a total of 6 doses may be instituted. 

The major uses of progestogens are for hormone replacement therapy and for hormonal contraception where they suppress ovulation and make the cervical mucus impenetrable to spermatozoa. Other indications include secondary amenorrhea, dysmenorrhea, infertility and habitual abortion and endometrium suppression in endometriosis. Progestogens are also used for palliation in metastasized endometrial and breast carcinoma. Medrogestone has been used in the treatment of fibroid uterine tumors. 

A 30-year-old woman has secondary amenorrhea and serum prolactin levels of 75 ng/mL. She has vis-... 

A 1978 WHO report quoted an unpublished study by March in which pituitary adenomas were found in 26% of women with secondary amenorrhea following the use of oral contraceptives, yet in only 13% of cases who had not used these products (118). The difference was significant, but selection bias might have explained the results. 

Since post-treatment amenorrhea of more than 6 months duration was first suggested as an adverse reaction in around 1965, much work has been devoted to delineating the risk and prognosis of menstrual changes after the withdrawal of hormonal contraception. It is now recognized that post-treatment amenorrhea occurs in 0.7-0.8% of women, but this is no different from the background rate of spontaneous secondary amenorrhea. No cause and effect relation between oral contraceptive use and subsequent amenorrhea has been documented. 

Warren MP, Biller BM, Shangold MM. A new clinical option for hormone replacement therapy in women with secondary amenorrhea effects of cyclic administration of progesterone from the sustained-release vaginal gel Crinone (4% and 8%) on endometrial morphologic features and withdrawal bleeding. Am J Obstet Gynecol 1999 180(1 Pt l) 42-8. 

In a study of women with polycystic ovary syndrome, 23 of 25 women with oligomenorrhea, four of five with secondary amenorrhea, and two of three with polymenorrhea achieved regular menstrual cycles after taking rosiglitazone 4 mg/day for 24 weeks. It may be worth informing women that their fertility may increase (121). 

Hyperprolactinemia occurred in a woman with secondary amenorrhea and hypertension who was taking large amounts of liquorice all the abnormalities reversed on withdrawal (242). 

Case (v) A 35-year-old female had primary infertility with secondary amenorrhea, ceasation of ovarian function and uterine fibroid tumour on the posterior wall at the junction of upper one-third and lower two-third of the uterus. Symptoms Amenorrhea for the last two years, obase, sweaty palms and soles, craving for eggs, irregular menstruation earlier. 

Zondek and 13-30 Cells (regular menstruation) 15-32 Cells (primary amenorrhea) 12-29 Cells (secondary amenorrhea) ... 

Medroxyprogesterone Cycrin, Provera, others Secondary amenorrhea, dysfunctional uterine bleeding, breast or endometrial carcinoma... 

It also has an effect on ATP-sensitive potassium channels in glucose-responsive neurones, which affect the neuronal firing rate. Leptin has major effects on reproductive behaviour (sexual maturation is delayed by lack of food). Starving women, female athletes and anorexics with low fat stores experience secondary amenorrhea. Leptin signalling defects lead to gross obesity, but these are very rare in humans. 

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