Adult-onset amenorrhea: a study of 262 patients

Abstract

A series of 262 patients with amenorrhea of adult onset are reported. Hypothalamic suppression followed by inappropriate positive feedback, and then hyperprolactinemia and ovarian failure are the most frequently encountered etiologies. Other etiologies are diverse and numerically less frequent. Amenorrhea after use of oral contraceptives, or postpill amenorrhea, occurred in 77 (29%) of all patients. The average age of presentation, prior menstrual history, associated morbidity, and subsequent reproductive potential of each diagnostic group are reported. Adult-onset amenorrhea has a less significant impact on future wellbeing than was reported for a similar-sized group of patients whose amenorrhea developed as a result of pubertal aberrancy.

PIP: This study evaluated the etiologic factors in 262 patients with adult-onset amenorrhea. Criteria for inclusion into the study included secondary amenorrhea of 6 months duration or more that was preceded by at least 6 menses after menarche and occurred before age 39 years. The average age of presentation in this series was 26.4 years. The 4 most common causes of amenorrhea were hypothalamic suppression (33.5%), chronic estrogenic anovulation (28%), hyperprolactinemia (14%), and ovarian failure (12%). This pattern contrasts with findings in an earlier study of women with pubertal amenorrhea in which the most common etiologies were ovarian failure (43%), congenital absence of the uterus and vagina (15%), and physiologic delay of puberty (14%). The data provide support for the common practice of obtaining a serum prolactin determination in women with amenorrhea. 54% of patients were hypogonadal on presentation while 46% were eugonadal. Amenorrhea after use of oral contraceptives (OCs) was found in 77 (29%) of cases, the majority of whom had normal cycles before OC use. It is suggested that OC users of reduced body weight may be at increased risk of postpill amenorrhea if they significantly reduce caloric intake during OC use to avoid the side effect of weight gain. It is further suggested that longterm OC use may stimulate galactoroph hyperplasia. In the present series, 48% of all patients with hyperprolactinemia had postpill amenorrhea and 17% of women with postpill amenorrhea were hyperprolactinemic. Analysis of morbidity data indicated that adult-onset amenorrhea presents less significant detrimental effects on the quality of life, including fertility, than pubertal amenorrhea. However, early diagnosis, treatment, and counseling remain essential for all patients.