Secondary Amenorrhoea
Secondary amenorrhoea is the cessation of menstrual periods for three or more consecutive months in a person who has previously menstruated. It is distinct from primary amenorrhea, where periods never begin. While it can resolve on its own, persistent absence of periods usually signals an underlying hormonal or structural issue worth investigating.
Key points
- Significant weight loss, intense exercise and chronic stress can all interrupt the hormonal signals that keep the menstrual cycle running.
- PCOS, thyroid problems, high prolactin and premature ovarian insufficiency are among the other recognised underlying causes.
- Medroxyprogesterone, given as a short progestogen course, can bring on a period and reveal whether oestrogen levels are within a healthy range.
Why periods stop
The most common triggers are significant weight loss, intense athletic training, and chronic stress, all of which suppress the hypothalamic signals that drive the menstrual cycle. Polycystic ovary syndrome (PCOS) is another frequent cause seen across women’s health consultations. Thyroid disorders, elevated prolactin levels, and premature ovarian insufficiency account for many of the remaining cases. Rarely, scarring inside the uterus (Asherman’s syndrome) physically prevents shedding.
Hormonal treatment options
When the cause is low progesterone or an absent withdrawal bleed, a short course of a progestogen is often used to trigger a period and confirm whether oestrogen levels are adequate. Medroxyprogesterone and dydrogesterone are the agents most commonly used for this purpose. Longer-term management depends on the root cause: PCOS may call for cycle regulation, while low body weight or overtraining requires addressing the underlying lifestyle factor first.
If periods have been absent for several months, see a doctor promptly, prolonged low oestrogen raises bone density concerns that are better caught early.