Secondary Amenorrhoea:-
Definition:- Secondary Amenorrhoea is the absence of menstruation for 6months or more in a woman in whom normal menstruation has been established.
Aetiology or causes:- The causes of true secondary amenorrhoea with the possible mechanisms are outlined:-
[A] Uterine factors:-
(1) Tubercular endometritis:-Destruction of the endometrium or inhibition of ovarian function by Tubercular toxin.
(2) Postradiation:-Destruction of the endometrium.
(3) Synechiae:-Intrauterine adhesions:- viscerocortical reflex:- amenorrhoea.
(4) Surgical removal :- Ablation of endometrium by laser, resectoscope.
[B] Ovarian factors:-
(1) Poly cystic ovarian syndrome:- Topically elevated LH (Luteinizing hormone):- Increased androgen production from the theca (PCOS) cells and stroma of the ovaries:-Decrease in SHBG (Sex hormone binding globulin):-increased unbound oestrogens and androgens:-Pituitary sensitivity to GnRH (Gonadotropin releasing hormone)is increased :- Preferential increased production of LH (Luteinizing hormone), decreased production of FSH (Follicle Stimulating Hormone) due to inhibin.
(2) Premature ovarian failure:- Absence of follicle or accelerated rate of depletion of follicles in the ovaries.
(3) Resistant ovarian syndrome (Savage’s syndrome):-Follicles are present but are resistant to gonadotrophins(defect in FSH receptor).
(4) Hyperoestrogenic state:- The oestrogen level remains high and there is no fluctuation. As such so long as endometrial support is not lust, amenorrhoea continues.
– Persistent follicles in metropathia (disease of uterus)
-Feminising tumour of the ovary.
(5) Masculinising tumour of the ovary (Sertoli-Leydig cell tumour):-Androgen excess opposes the effect of oestrogen on the endometrium.
(6) Hypo-estrogen state:- Ablation of the ovaries -Removal of the site of production of oestrogens.
Dr Priyanka Baisya
