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Amenorrhea is the absence of menstrual bleeding and can be classified as either primary or secondary. Amenorrhea is defined as primary if menstruation has not occurred but secondary sex characteristics are present at age 16. Amenorrhea is defined as secondary if menstruation has previously occurred but has now ceased for 3 months in a woman with a history of regular bleeding, and 6 months in a woman with history of irregular periods. Amenorrhea is a symptom, not a diagnosis.[1]


Causes Dietary Factors, Smoking, Stress
See Also Women's Health, Uterine Fibroids, Ovarian Cysts
Books Books on Women's Health
Articles Articles on Women's Health

Naturopathic Assessment

Causal Factors

In order to stimulate the innate ability of the body to heal the causes of disease must be identified and addressed. With amenorrhea, the causes are variable and include genetics, lifestyle and social factors. A detailed assessment is required to determine which factors are contributing to amenorrhea.


  • Inadequate intake of calories or dietary fat or loss of a lot of weight suddenly, for example a strict diet, can all cause amenorrhea.
  • Eating disorders such as anorexia and bulimia are associated with amenorrhea.[2], [3]
  • Exercise induced amenorrhea is often seen in female athletes. Though the cause is thought to be the combination of excessive exercise and energy deprivation.[4]
  • It has been suggested that a critical amount of body fat is necessary to ensure menstruation, other studies present evidence to the contrary.[5] However, when leptin (a hormone which represents body fat stores) was administered to women with amenorrhea due to increased exercise or low weight, menstrual and ovulatory status improved, thus indicating a role of body fat or energy reserve.[6]


  • Severe anxiety and emotional distress are associated with amenorrhea, especially secondary amenorrhea.
  • It is common for periods to be delayed or to stop completely for a number of months following an extreme emotional trauma.


  • Severe pelvic infections can result in loss of periods.


Medical Interventions

  • Prescription Medications
  • Women who are taking birth control pills or receive hormone shots such as Depo-Provera may not have any monthly bleeding. When they stop taking these hormones, their periods may not return for more than 6 months.
  • Medications such as Busulfan, chemotherapy drugs for cancer, Chlorambucil, Cyclophosphamide, Phenothiazines.
  • Medical Procedures
  • Gastric bypass surgery has been associated with amenorrhea.
  • A D&C (dilation and curettage) can cause a type of amenorrhea referred to as Asherman's syndrome. A D&C can cause scar tissue formation that may cause a woman to stop menstruating.[7]


  • Chromosomal abnormalities, testicular feminization syndrome or being born with poorly formed genital or pelvic organs (missing uterus or vagina, vaginal septum, cervical stenosis, or imperforate hymen) can lead to primary amenorrhea.

Diagnostic Testing

A full history and physical exam are required as the following diagnostic tests:

  • Blood tests including a pregnancy test, progesterone challenge test and hormone testing. Other blood tests that may be indicated include 17 hydroxyprogesterone or chromosome analysis.
  • Imaging tests that may be used include Magnetic Resonance Imaging (MRI) and an ultrasound,[8], CT scan of the head, laparoscopy or pelvic ultrasound, endometrial biopsy

Related Symptoms and Conditions

Both primary and secondary amenorrhea are associated with the following conditions:

  • Low body fat - having less than 15% - 17% increases the likelihood of amenorrhea.
  • Eating disorders such as anorexia nervosa and bulimia
  • Obesity
  • Brain (pituitary) tumors
  • Polycystic ovarian syndrome
  • Hypothyroidism or Hyperthyroidism

Additional conditions associated with primary amenorrhea include:

  • Adrenogenital syndrome
  • Chromosomal abnormalities such as Turner syndrome or Sawyer syndrome
  • Congenital heart disease (cyanotic)
  • Congenital adrenal hyperplasia
  • Craniopharyngioma
  • Chronic (long-term) illnesses
  • Cushing's disease
  • Cystic fibrosis
  • Gonadal dysgenesis
  • Hypogonadotropic hypogonadism
  • Hyperprolactinemia
  • Prader-Willi syndrome
  • Testicular feminization
  • True hermaphroditism
  • Tumors of the ovaries

Additional conditions associated with secondary amenorrhea include:

  • Premature ovarian failure

Complications associated with amenorrhea include:


Amenorrhea is the absence of menstruation.

  • Primary amenorrhea is when a girl has not yet started her monthly periods, and she has gone through other normal changes that occur during puberty and is older than 15.
  • Secondary amenorrhea occurs when menstruation has previously occurred but has now ceased for 3 months in a woman with a history of regular bleeding, and 6 months in a woman with history of irregular periods.
  • In cases of secondary amenorrhea, pregnancy most always be ruled out.
  • Women who are pregnant, breastfeeding, or in menopause are not considered to have secondary amenorrhea.

Depending on the underlying cause of amenorrhea, other symptoms can occur including:

  • Changes in breast size
  • Change in weight (with gain or loss)
  • Galactorrhea (discharge from the breast)
  • Headache
  • Increased hair growth in a "male" pattern (hirsutism) and acne
  • Vaginal dryness
  • Voice changes

Naturopathic Treatment

The goal of naturopathic treatment is to support and work in tandem with the healing power of the body and to address the causal factors of disease with individual treatment strategies. Amenorrhea is a symptom of an underlying condition or other causal factor. It is always important to identify and address the underlying condition or factors as a means of restoring normal menstruation.

It is always advisable to work with a naturopathic doctor before engaging in any treatment plan.


Lifestyle recommendations include:

  • Ensure you are consuming adequate calories and dietary fat to avoid becoming underweight or obese..
  • Ensure you drink adequate water.
  • Exercise is an important part of a healthy lifestyle, but avoid excessive exercise.

Naturopathic Therapies

Naturopathic Therapies for amenorrhea include:

  • Acupuncture can be effective in restoring normal menstruation in those with secondary amenorrhea.


Reviewed by Iva Lloyd, BScH, RPE, ND [1]

  1. 1.0 1.1 El-Hashemy Shehab, Skowron Jared, Sorenson Linda (2011) Textbook of Naturopathic Family Medicine & Integrative Primary Care: Standards & Guidelines CCNM Press. P 376.
  2. 2.0 2.1 Johnson J, Whitaker AH (Jan 1992) Adolescent smoking, weight changes, and binge-purge behavior: associations with secondary amenorrhea. Am J Public Health.;82(1):47-54. PMID: 1536334.
  3. Selzer R, Caust J, Hibbert M, Bowes G, Patton G (Jul 1996) The association between secondary amenorrhea and common eating disordered weight control practices in an adolescent population. J Adolesc Health.;19(1):56-61. PMID: 8842861.
  4. Warren MP (1999 Jun) Health issues for women athletes: exercise-induced amenorrhea J Clin Endocrinol Metab; Vol84(6):1892-6. PMID: 10372682.
  5. Sanborn CF, Albrecht BH, Wagner WW Jr (1987 Jun) Athletic amenorrhea: lack of association with body fat Med Sci Sports Exerc; Vol19(3):207-12.
  6. Welt CK, Chan JL, Bullen J, Murphy R, Smith P, DePaoli AM, Karalis A, Mantzoros CS (Sep 2004) Recombinant human leptin in women with hypothalamic amenorrhea N Engl J Med; Vol351(10):987-97. PMID: 15342807.
  7. March CM (Mar 2011) Asherman's syndrome Semin Reprod Med.;29(2):83-94. PMID: 21437822.
  8. 8.0 8.1 Master-Hunter T, Heiman DL (2006 Apr) Amenorrhea: evaluation and treatment Am Fam Physician; Vol73(8):1374-82. PMID: 16669559.
  9. 9.0 9.1 Hudson T (2007) Women's Encyclopedia of Natural Medicine: Alternative Therapies and Integrative Medicine for Total Health. McGraw-Hill.
  10. Godfrey Anthony, Saunders Paul Richard, Barlow Kerry, Gilbert Cyndi, Gowan Matthew, Smith Fraser 2010 Principles and Practices of Naturopathic Botanical Medicine, Vol 1: Botanical Medicine Monographs, CCNM Press, Toronto
  11. Boon Heather, Smith Michael 2004 The Complete Natural Medicine Guide to the 50 Most Common Medicinal Herbs, Robert Rose, Toronto
  12. Hershoff Asa 2000 Homeopathic Remedies, A Quick and Easy Guide to Common Disorders and their Homeopathic Treatments, Avery Publishing Group, New York
  13. Ullman Robert, Reichenberg-Ullman Judyth 1997, Homeopathic Self-Care, the quick and easy guide for the whole family. Prima Publishing