Ovarian causes
The ovaries can fail to respond to pituitary hormones. This occasionally happens in women younger than the expected age of menopause, though rarely for women under 30 years of age. Ovaries often fail after treatment of cancer (in any part of the body) with radiation or chemotherapy, but in most other cases the cause of premature menopause is obscure. Treatment by replacement of ovarian hormones is essential to preserve health, and will restore menstruation.
• polycystic ovaries can cause secondary amenorrhoea as can, of course, the destruction of the ovaries by disease or removal by surgery.
Uterine causes
These causes of secondary amenorrhoea are rare. The inner layer of the endometrium may be too deeply removed during curettage, so that there is little left from which a new endometrium can regrow in the next cycle and scar tissue begins to close the uterine cavity. This is called Asherman’s syndrome. It is most likely to happen – though still rare – during curettage for incomplete abortion or after childbirth. It is extremely rare after induced abortion by suction aspiration. For treatment a non-copper IUD is inserted to hold the cavity open enough to prevent scarring and allow the endometrium to regrow from the remaining fragments.
Very rarely the cervical canal may become closed by scar tissue after cervical surgery or tearing during childbirth. The treatment is to reopen the canal by surgery.
Secondary amenorrhoea always needs investigation and usually treatment. Tests to find the cause include blood tests for hormones; X-ray or CAT scan of the skull if pituitary tumour is suspected; hysterosal-pingogram if Asherman’s syndrome is a possibility; pelvic ultrasound, laparoscopy or laparotomy to discover ovarian abnormalities.
Whether treatment can restore menstruation depends on the cause. However, if there is a lack of ovarian hormones for any reason, hormone replacement should be started within six months to preserve general health and especially bone health.
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