Evaluation and Management of Secondary Amenorrhea: A Case Series in a Tertiary Care Centre

Abstract

Background: Amenorrhea, defined as the absence of menstruation, is a symptom indicative of underlying health issues rather than a disease itself. Secondary amenorrhea is characterized by the cessation of established menstruation for six months or longer, or alternatively, previously regular menses for three months or previously irregular menses for six months. The incidence of secondary amenorrhea is estimated to be 3% to 4% among women in the general population. Aim: This study aims to evaluate the etiology, diagnostic approaches, and management strategies for secondary amenorrhea among patients presenting to the gynecology outpatient department at MKCG Medical College, Berhampur, Odisha, India. Methods: A total of 25 patients diagnosed with secondary amenorrhea were included in this study. A comprehensive evaluation was conducted, including detailed medical history, physical examination, laboratory investigations (hormonal profile, thyroid function tests, prolactin levels), and imaging studies (ultrasound, MRI). Management strategies were individualized based on the etiology and included medical, surgical, and lifestyle interventions. Results: The study identified various etiologies for secondary amenorrhea, including hormonal imbalances, structural abnormalities, and systemic conditions. The individualized management plans led to successful outcomes in most cases, with resumption of menstruation and improvement in symptoms. Specific cases highlighted include prolactinoma, PCOS, premature ovarian insufficiency, and Asherman’s syndrome, each requiring distinct diagnostic and therapeutic approaches. Conclusion: Secondary amenorrhea presents with diverse etiologies, necessitating a thorough and multidisciplinary approach for diagnosis and management. Early and accurate diagnosis, along with tailored interventions, are crucial for effective treatment and improved patient outcomes. Recommendations: Implementation of standardized protocols for the evaluation of secondary amenorrhea in clinical practice. Encourage multidisciplinary collaboration for the management of complex cases. Promote patient education regarding the potential causes and treatments for secondary amenorrhea. Conduct further research to explore long-term outcomes of various management strategies.Enhance awareness among healthcare providers about the importance of early intervention. Keywords: Secondary Amenorrhea, Hormonal Imbalance, PCOS, Premature Ovarian Insufficiency, Tertiary Care