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.
|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|
- 1 Naturopathic Assessment
- 2 Characteristics
- 3 Naturopathic Treatment
- 4 References
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.
- Exercise induced amenorrhea is often seen in female athletes. Though the cause is thought to be the combination of excessive exercise and energy deprivation.
- It has been suggested that a critical amount of body fat is necessary to ensure menstruation, other studies present evidence to the contrary. 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.
- 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.
- 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.
- 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.
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,, 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
- 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
- Chronic (long-term) illnesses
- Cushing's disease
- Cystic fibrosis
- Gonadal dysgenesis
- Hypogonadotropic hypogonadism
- 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:
- Increased risk of fractures
- Emotional distress due to fear of not being able to get pregnant.
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)
- Increased hair growth in a "male" pattern (hirsutism) and acne
- Vaginal dryness
- Voice changes
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:
- Exercise is an important part of a healthy lifestyle, but avoid excessive exercise.
Naturopathic Therapies for amenorrhea include:
- Clinical Nutritional Supplementation includes
- Botanical remedies such as Chaste Tree (Vitex agnus-castus), Dong Quai (Angelica sinensis), Golden Rod (Solidago virgaurea), Fennel (Foeniculum vulgare), Motherwort (Leonurus cardiaca), Rhodiola ( Rhodiola rosea), Black Cohosh (Cimicifuga racemosa).,  and Maca (Lepidium meyenii). Nettle (Urtica dioica)
- Homeopathic remedies such as Graphites, Kali carb, Natrum muriaticum, Pulsatilla, Senecio, Sepia., 
- Acupuncture can be effective in restoring normal menstruation in those with secondary amenorrhea.
Reviewed by Iva Lloyd, BScH, RPE, ND 
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