This page has moved. Click here to view. The most common cause of secondary amenorrhea is the development of chronic hypothalamic anovulation, which can be induced by stress, increased exercise levels, a precipitous decrease in body weight, or the development of an inappropriate ratio of lean body mass to fat. If pregnancy is ruled out, the patient with chronic hypothalamic anovulation is found to have normal gonadotropin levels with an appropriate ratio of LH to FSH and will respond with withdrawal bleeding to a progestogen challenge. Rare causes of amenorrhea include its association with temporal arteritis or cavernous sinus thrombosis.
Pituitary dysfunction can likewise result in secondary amenorrhea.
Perhaps the most common cause is functional hyperprolactinemia, which is thought by many investigators to represent a disorder of central dopamine metabolism or to indicate the presence of prolactinomas. Hyperprolactinemia is diagnosed by Hypothyroidism can at times result in menstrual dysfunction and may or may not be associated with hyperprolactinemia. The patient with hypothyroidism may present with dry skin, lethargy, and Disorders of adrenal metabolism likewise can result in the development of secondary amenorrhea. This elevation may be corticotropin dependent or independent and is best evaluated by a 24-hour urine measurement of free cortisol. Interpretation of the 24-hour urine measurement is based on knowledge of the patient's creatinine clearance.