What are the Causes of Secondary Pathological Amenorrhea?

Amenorrhea is absence of menstruation in a woman. There are many causes of secondary pathological amenorrhea and they are listed below:

1. Obstruction (acquired) to the lower genital tract -lower genital tract injury due to operation, chemical burns etc. which can lead to stenosis (narrowing) of cervix and rarely of vagina.
2. Ovarian factors of secondary pathological amenorrhea:

• Polycystic ovarian disease formerly known as Stein-Leventhal syndrome; hyperthecosis ovarii etc.
• Ovarian failure or hypo hormonal amenorrhea.
• Hyper hormonal amenorrhea-due to excess estrogen as seen in metropathia hemorrhagica and may be due to therapeutic use of hormone.
• Ovarian destruction of ovaries by disease (rare cause), radiation or surgical removal of ovaries known as oophorectomy.
• Premature menopause due to auto immune disease or due to ovarian resistance syndrome.
• Masculinizing tumors of ovaries like arrhenoblastoma, adrenal like tumors, hillus cell tumor, masculinizing luteoma etc.
• Hysterectomy or surgical removal of uterus.
• Destruction of endometrium of uterus due to-genital tuberculosis, attachment due to excess and vigorous curettage after abortion, or due to intra cavity introduction of radium in uterus.
• Basophil adenoma-Cushing’s disease.
• Acidophil tumor- which produce gigantism and acromegaly.
• Oral contraceptive pills and psychotropic drugs that cause hyperprolactinemia.
• Pituitary failure due to cyst, post partum pituitary necrosis (Sheehan’s syndrome), chromophobe adenoma, Simmond’s disease etc.
• Prolactinoma causing hormonal disturbance.
• Psychogenic causes- anorexia nervosa, stress, pituitary shock, vigorous exercise, pseudocyesis etc.
• Suppression of FSH (follicle stimulating hormone) due to persistence of luteotropic hormone as seen in Chiari-Frommel syndrome.

3. Uterine factors:

4. Diseases affecting pituitary:

5. Amenorrhea due to chromosomal abnormalities.
6. Nutritional causes- due to extreme obesity or extreme nutritional deficiency.
7. Thyroid causes- hyperthyroidism, late stage of hypothyroidism.
8. Systemic diseases- diabetes mellitus, severe anemia, debilitating diseases like renal disease and fulminanting tuberculosis.
9. Adreno-genital syndrome (adrenal cortical hyperplasia), Addison’s disease (adrenal failure), adrenal cortical tumors.