Hello and welcome to the Zero to Finals podcast. My name is Tom and in this episode I'm going to be

talking you through Secondary Amenorrhea. And you can find written notes on this topic at

zero tofinals.com slash secondary amenorrhea or in the gynecology section of the zero to finals obstetrics and gynecology book.

So let's get straight into it.

Secondary amenere is defined as no menstruation for more than three months after previously having

regular menstrual periods.

Consider assessment and investigation after three to six months without periods.

In women with previously infrequent irregular periods,

consider investigating after six to 12 months.

So what are the causes of secondary amenorrhea?

The most common cause is pregnancy, so it's always

worth doing a pregnancy test. Other causes are menopause and premature ovarian failure, which is early

menopause, hormonal contraception, such as the intrautrine system or myrinaina coil or the progesterine only pill

hypothalamic or pituitary pathology ovarian causes such as polycystic ovarian syndrome

uterine pathology such as as as shaman syndrome thyroid pathology and hyperprolactanemia. The hypothalamus reduces the production of

gonadotrophin releasing hormone or GNRH in response to significant physiological or psychological stress,

and this leads to hypogonadotropic hypogonadism and amenorrhea. Essentially, a lot of stress on the body

or psychological stress can cause the hypothalamus to stop secreting hormones that then result in the

absence of the normal menstrual cycle. The hypothalamus responds in this way to prevent pregnancy in situations where the body

may not be fit for it. For example, with excessive exercise, think of this in athletes, low body weight

and eating disorders, chronic disease and significant psychological stress. The pituitary gland can also cause

secondary amenorrhea when there's pathology such as pituitary tumors, particularly prolactin

...