Secondary Amenorrhoea



This means that menstruation stops after having occurred normally for a given length of time.

There are many causes, and the most common and obvious are due to pregnancy and the menopause.



Many psychogenic factors can have this effect, and apparently simple occurrences such as tensions, stresses. altering one’s place of employment or hours of work, or bereavement, are all well known. Many women who were taken prisoners during wartime experienced this symptom. Being overanxious to become pregnant is another well-documented cause. There are also endocrine reasons, such as Cushing’s syndrome and excess secretion of the thyroid hormone (hyperthyroidism) or excesses due to tumours of the pituitary gland.

The contraceptive pill is well-known for its ability to induce secondary amenorrhoea, even when taken for relatively short periods of time, as short as three to six months. It also occurs in women who have taken it for many years without a break, and comes as a rude shock when they hope to plan their family and become pregnant as soon as the pill is discontinued.



Symptoms

The condition may come on suddenly (as when the pill is stopped), or it may be preceded by reduced menstrual flow for some time.



Hot flushes and other symptoms typical of the menopause indicate reduced ovarian function. In those with pituitary disorders, there may be an indication of other hormonal deficiencies as well. If there is excessive androgen secretion (male hormone), evidence of virilisation (facial hair, muscular development) may be obvious.

Secondary Amenorrhoea Treatment



This will depend on the primary cause, if one can be found. Sometimes hormonal medication may be used in the hope of re-establishing normal cycles. However, this is frequently impractical, particularly in women who have already been on this sort of medication in taking the pill. Clomiphene has been shown to be of value in re-establishing the cycle, particularly if due to psychogenic causes or to a gonadotrophin secretory failure.

More recently spectacular results have been gained from the use of bromocriptine. It has been found that many women with amenorrhoea have abnormally high prolactin levels. This hormone is produced by the pituitary, and in above normal levels inhibits ovulation.



Bromocriptine reduces levels to normal, allows ovulation and hence a return to normal menstrual patterns. Pregnancy is possible almost at once, and the drug seems safe and virtually devoid of adverse side effects. It has introduced a totally new element of hope for these women. The techniques of radioimmunoassay have enabled accurate plasma levels of prolactin to be measured, previously an impossibility, and this has helped in perfecting its use. It certainly will not cure all cases, but represents a major step forward.

In particular, women who once believed they were permanently infertile arc finding that pregnancy can be achieved with treatment that may only require a few months. Already many women have been delivered of normal, healthy infants following bromocriptine treatment.