According to the paper, tumors on the pituitary gland, low estrogen levels, high testosterone levels, and overactive thyroid glands cause hormonal imbalances. Testosterone contributes in the growth and development of reproductive tissues in women and excessive supply of it has been associated with irregular or absence of menstrual periods. Hormonal birth control can contribute to secondary amenorrhea. Drugs and medical treatments such as chemotherapy and antipsychotic drugs can also induce secondary amenorrhea. Polycystic ovary syndrome is associated with weight changes that are an important lifestyle factor in secondary amenorrhea. Overweight and body fat that is less than fifteen percent are some of the things that can stop menstrual periods. The National Institute of Health (NIH) records that extreme diet has causal links with secondary amenorrhea. Emotional stress is a non-physical element that can cause secondary amenorrhea. Derailed menstrual cycle is one of the ways that the body uses to respond to extreme stress. Mild hypothyroidism is one of the conditions that could precede presentation of dysmenorrhea and irregular menstrual cycles. However, mild hypothyroidism is associated with hypermenorrhea and oligomenorrhea more than with amenorrhea. Treating hypothyroidism restores menses but it may take months. Cushing’s disease is the hyperactivity of adrenal glands and can combine with hypothyroidism to cause amenorrhea. Outflow tract obstruction, hyperandrogenic chronic, anovulation are some of the conditions in a patient’s history that can be helpful in the diagnosis and treatment of dysmenorrheal. Asherman’s syndrome is a common cause of outflow obstruction in secondary dysmenorrhea. This syndrome is a scarring and an intrauterine synechiae that results from curettage or infection.