Secondary amenorrhea is much more common in compare to primary amenorrhea and there are several causes of secondary amenorrhea. The following are the causes of secondary amenorrhea.

Pregnancy:

This is the most common cause of secondary amenorrhea, especially if the women are normal and sexually active and in reproductive age group.

Use of contraceptive:

Some women (although very few of them) may not menstruate if they are taking oral contraceptive pills. Menstruation may not start after stopping pills, as it may take three months or more for ovulation to start after stopping contraceptive pills, especially with progesterone containing pills.

Breast feeding & secondary amenorrhea:

Mothers who breast feed their babies may experience amenorrhea for few months after delivery. During breast feeding it is possible to have ovulation in absence of menstruation and as a result pregnancy can occur without menstruation.

Medications & secondary amenorrhea:

Certain medications may affect menstruation and cause amenorrhea. Some examples of medications that can cause secondary amenorrhea are some anti cancer drugs, oral corticosteroids, antidepressants and antipsychotic drugs.

Hormonal imbalance:

PCOS or polycystic ovarian syndrome, a hormonal disorder is a common cause of amenorrhea. There is high and sustained level of estrogen and androgen (normally there is fluctuating level) in PCOS and result in amenorrhea.

Low body weight & secondary amenorrhea:

Excessively low body weight can cause menstruation to stop, as seen in eating disorder anorexia nervosa. Extremely low body weight cause hormonal imbalance and amenorrhea may result.

Stress:

Mental stress, especially if present for long duration may result in amenorrhea due to abnormal functioning of hypothalamus. Menstruation usually resume if stress is removed or reduced.

Excessive physical exercise & secondary amenorrhea:

Excessive exercise as done by athletes such as long distance runners may have disturbed menstrual periods due to low body fat, excess energy expenditure, stress etc.

Thyroid problems:

Thyroid problems such as under active thyroid which cause hypothyroidism may cause amenorrhea. In hypothyroidism prolactin level is reduced which affect hypothalamus and cause amenorrhea.

Pituitary problems:

Some pituitary problems such as tumor in pituitary such as prolactinoma (which cause increase production of prolactin) can cause amenorrhea.

Scar in uterus:

There may be scar formation in uterus after surgical procedures in uterus such as caesarean section, removal of fibroid, dilatation and curettage (D & C) etc. Scar in uterus cause interruption in normal build up and shedding of the uterine lining, which may cause scanty menstrual bleeding or no bleeding at all.

Primary Ovarian insufficiency:

Normally menopause occurs in between 45 and 55 years of age. But in some cases there may be primary ovarian insufficiency and menopause may occur at the age of 40 years or before, due to lack of ovarian function. Primary ovarian insufficiency, also called as premature menopause may be due to genetic factors or autoimmune disease, but in most cases a cause can not be found.

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