<P> Secondary amenorrhea is caused by low levels of the hormone leptin in females with low body weight . Like ghrelin, leptin signals energy balance and fat stores to the reproductive axis . Decreased levels of leptin are closely related to low levels of body fat, and correlate with a slowing of GnRH pulsing . </P> <P> When a woman is experiencing amenorrhoea, an eating disorder, and osteoporosis together, this is called female athlete triad syndrome . A lack of eating causes amenorrhoea and bone loss leading to osteopenia and sometimes progressing to osteoporosis . </P> <P> The social effects of amenorrhoea on a person vary significantly . Amenorrhoea is often associated with anorexia nervosa and other eating disorders, which have their own effects . If secondary amenorrhoea is triggered early in life, for example through excessive exercise or weight loss, menarche may not return later in life . A woman in this situation may be unable to become pregnant, even with the help of drugs . Long - term amenorrhoea leads to an estrogen deficiency which can bring about menopause at an early age . The hormone estrogen plays a significant role in regulating calcium loss after ages 25--30 . When her ovaries no longer produce estrogen because of amenorrhoea, a woman is more likely to suffer rapid calcium loss, which in turn can lead to osteoporosis . Increased testosterone levels cause by amenorrhoea may lead to body hair growth and decreased breast size . Increased levels of androgens, especially testosterone, can also lead to ovarian cysts . Some research among amenorrhoeic runners indicates that the loss of menses may be accompanied by a loss of self - esteem . </P> <P> Certain medications, particularly contraceptive medications, can induce amenorrhoea in a healthy woman . The lack of menstruation usually begins shortly after beginning the medication and can take up to a year to resume after stopping a medication . Hormonal contraceptives that contain only progestogen like the oral contraceptive Micronor, and especially higher - dose formulations like the injectable Depo Provera commonly induce this side effect . Extended cycle use of combined hormonal contraceptives also allow suppression of menstruation . Patients who use and then cease using contraceptives like the combined oral contraceptive pill may experience secondary amenorrhoea as a withdrawal symptom . The link is not well understood, as studies have found no difference in hormone levels between women who develop amenorrhoea as a withdrawal symptom following the cessation of OCOP use and women who experience secondary amenorrhoea because of other reasons . New contraceptive pills, like continuous oral contraceptive pills (OCPs) which do not have the normal 7 days of placebo pills in each cycle, have been shown to increase rates of amenorrhoea in women . Studies show that women are most likely to experience amenorrhoea after 1 year of treatment with continuous OCP use . </P>

Amenorrhea is often associated with lower estrogen levels and an increased risk of ____.​