Which of the following are common causes of secondary amenorrhea?

• A. Hormonal disorders, excessive exercise, weight loss/eating disorders, and stress.
• B. Pregnancy and menopause.
• C. Only stress.
• D. Infections.

Answer: (A)

Secondary amenorrhea happens when someone who has had regular cycles stops having menses for a substantial period due to disruption of the signals that drive ovulation. The best answer reflects the most common reversible triggers of that disruption: hormonal disorders, excessive exercise, weight loss or eating disorders, and stress.

Hormonal disorders—such as thyroid dysfunction or elevated prolactin—disturb the hypothalamic-pituitary signals that normally trigger ovulation. Prolactin, in particular, inhibits GnRH, which reduces FSH and LH, leading to reduced estrogen and missed periods.

Energy balance factors matter a lot. When there’s an energy deficit from intense training, significant weight loss, or eating disorders, the body conserves energy and dampens GnRH release. That dampening lowers ovarian activity and halts menses.

Stress adds another layer; chronic stress raises cortisol and related hormones that can alter hypothalamic signaling, again reducing GnRH pulsatility and ovulation.

Pregnancy and menopause are indeed common contexts for absent menses, but in the framework of secondary amenorrhea’s typical reversible causes, the focus is on these functional and endocrine factors. They represent the most frequent, modifiable pathways behind the condition.