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.
  1. Uterine factors:
  1. Diseases affecting pituitary:
  1. Amenorrhea due to chromosomal abnormalities.
  2. Nutritional causes- due to extreme obesity or extreme nutritional deficiency.
  3. Thyroid causes- hyperthyroidism, late stage of hypothyroidism.
  4. Systemic diseases- diabetes mellitus, severe anemia, debilitating diseases like renal disease and fulminanting tuberculosis.
  5. Adreno-genital syndrome (adrenal cortical hyperplasia), Addison’s disease (adrenal failure), adrenal cortical tumors.
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