A cross-sectional study on factors associated with secondary amenorrhoea among the students who attended Polyclinic Universiti Malaysia Sabah with irregular menstruation
Authors: Than Win Win , Parash M Tanveer Hossain , Majeed Nathira binti Abdul , Yin Khin Nyein , Baharuddin Dg Marshitah binti Pg , Fahmy Ehab Helmy Abdel Malek , Daud Mohd Nazri bin Mohd 
Published: February 2023

Abstract
Background
The menstruation is considered as an indicator of women’s health. A woman who menstruates regularly (every 21–45 day) is considered to have secondary amenorrhea if she has not menstruated in 3 months or 6 months if she menstruates previously irregular. Hypothalamic amenorrhea (HA) and polycystic ovary syndrome (PCOS) are the two most common causes of secondary amenorrhoea, other than pregnancy. The changes in the female hormone levels are associated with health behaviours, obesity, and stress. High stress has been shown to affect the hypothalamic–pituitary–adrenal (HPA) axis activity, whereas high body mass index (BMI) has been demonstrated to influence the sex hormone-binding globulin (SHBG), free androgen index (FAI), testosterone, and insulin levels.
Objectives
The objective of the study is to study body mass index (BMI), stress score and hormonal levels on students from Universiti Malaysia Sabah (UMS) who attended Polyclinic UMS with irregular menstruation to detect the causes of irregular menstruation and to give specific treatment to improve their quality of life.
Method
Cross-sectional study was carried out during the period starting from 1st January 2021 until 31st December 2022 on UMS students with an age range of (19–35 years), both undergraduate and postgraduate, attended the Polyclinic UMS for irregular menstruation. The subjects who received hormonal treatment in the past six months, with organic lesions of the genital tract, with bleeding disorders, and with pregnancy, were excluded from the study. In this study total of 100 participants were included through stratified random sampling where 60 subjects were recruited who fulfilled the selection criteria, and the rest 40 subjects were recruited as matched controls.
Result
As the subjects were selected as matched pairs, both the groups had a similar frequency of different BMI grades. The p-value was higher than the level of significance, α = 0.05 and there was insufficient evidence to reject the null hypothesis. There were some apparent differences in the frequencies of depression, anxiety, and stress (DASS 21 score) between the two groups. The p-values for depression (0.004), anxiety (< 0.001), and stress (0.003) were less than the level of significance, α = 0.05 and the null hypothesis was rejected. The p-values of LH, testosterone, oestradiol, and TSH were lower than the significant level α = 0.05, but for FSH, prolactin and free T4 were higher. There was sufficient evidence to reject the null hypothesis for LH, testosterone, oestradiol, and TSH, but the evidence was insufficient to reject the null hypothesis for FSH, prolactin, and free T4. Hence, there was a significant difference in LH, testosterone, oestradiol, and TSH levels.
Conclusion
The causes of secondary amenorrhoea in students from Universiti Malaysia Sabah (UMS) who attended Polyclinic UMS with irregular menstruation were functional hypothalamic amenorrhoea due to stress with or without weight loss and polycystic ovary syndrome due to overweight and obesity as well as chronic life stressful events. Lifestyle modification and stress management are first-line treatment plans to improve their quality of life.