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Amenorrhea

Also listed as: Menstruation - absence of

• Signs and Symptoms
• What Causes It?
• What to Expect at Your Provider's Office
• Treatment Options
• Special Considerations
• Supporting Research

Amenorrhea is the absence of menstruation. When a girl reaches age 16 and has not begun menstruating, she may have primary amenorrhea. When a woman who has had menstrual cycles misses three periods in a row, she is considered to have secondary amenorrhea. A hormone imbalance can cause hypoestrogenemic amenorrhea. An excess of prolactin, a hormone that stimulates milk production, can also cause amenorrhea.

Signs and Symptoms

Symptoms of primary amenorrhea may include:

• Headaches
• Abnormal blood pressure
• Vision problems
• Acne
• Excessive hair growth
• Sometimes either a short, stubby physique or extremely tall stature

Symptoms of secondary amenorrhea may include:

• Nausea
• Swollen breasts
• Headaches
• Vision problems
• Unusual thirst
• Goiter (an enlarged thyroid gland)
• Darkeing skin
• Extreme weight loss
• Alcoholism
• Liver disease,
• Kidney failure.

Hot flashes, mood changes, depression, and vaginal dryness are common with estrogen deficiency.

What Causes It?

Generally, the causes of amenorrhea include certain genetic defects, body structure abnormalities, or endocrine disorders. Specific causes include the following.

• Developmental problems, such as the absence of the uterus or vagina
• Hormone imbalance produced by the endocrine system
• Excessive amounts of the male hormone testosterone
• Improper functioning of the ovaries
• Intrauterine infection or endometritis
• Menopause, usually between the ages of 40 and 55
• Pregnancy or breast-feeding
• Discontinuation of oral contraceptives
• Disease (such as diabetes or tuberculosis)
• Stress or psychological disorders
• Malnutrition, extreme weight loss, anorexia nervosa
• Extreme overweight (obesity)
• Extreme exercise (such as long-distance running)
• Drug abuse

What to Expect at Your Provider's Office

Your provider will conduct a physical examination, which will include an internal pelvic examination. Laboratory tests may include analysis of mucus from the cervix and uterus, blood tests, computer assisted tomography (CAT) scan, magnetic resonance imaging (MRI), or ultrasound.

Treatment Options

Your health care provider will treat your condition based on the underlying cause. Treatments include hormone therapy, psychological counseling and support, and surgery, among others.

Drug Therapies

Your health care provider may suggest the following drugs:

• Oral contraceptives or hormones to cause menstruation to start.
• Estrogen replacement for low levels of estrogen caused by ovarian disorders, hysterectomy, or menopause. Women with an intact uterus should receive estrogen plus progesterone or progestins. Estrogen or hormone replacement therapy has both benefits and risks. Post-menopausal women who take hormone replacement therapy have lower numbers of hip fractures and colorectal cancer, but higher incidence of breast cancer, stroke, heart disease, and blood clots in the lungs. Ongoing studies are evaluating the risks and benefits, so be sure to discuss both with your doctor.
• Progesterone to treat ovarian cysts and some intrauterine disorders.

Complementary and Alternative Therapies

Alternative therapies may help the body metabolize hormones while helping the body meet normal nutritional requirements for hormone production.

Nutrition and Supplements

Eat fewer processed foods, and limit animal products. Limit the cruciferous family of vegetables (cabbage, broccoli, brussel sprouts, cauliflower, kale). Eliminate methylxanthines (coffee, chocolate). Eat more whole grains, organic vegetables, and omega-3 fats (cold-water fish, nuts, and seeds). In addition, you may take the following supplements.

• Calcium (1,000 mg per day), magnesium (600 mg per day), vitamin D (200 to 400 IU per day), vitamin K (1 mg per day), and boron (1 to 3 mg per day).
• Zinc (30 mg per day), vitamin E (800 IU per day), vitamin A (10,000 to 15,000 IU per day), vitamin C (250 to 500 mg two times per day), and selenium (200 mcg per day). High doses of vitamin A can pose risks to the fetus during pregnancy. Talk to your doctor for proper dosing levels.
• B6 (200 mg per day) may reduce high prolactin levels.
• Essential fatty acids: Evening primrose or borage oil (1,000 to 1,500 mg one to two times per day).

Progesterone is sometimes available as an over-the-counter oral supplement. However, this hormone that should never be taken without your doctor's supervision.

Herbs

You can use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). People with a history of alcoholism should not use tinctures. Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day.

Many of these herbs have an estrogen-like effect. Avoid these herbs if you have a history or family history of cancers associated with estrogen, including breast, cervical, uterine and ovarian cancer.

• For elevated prolactin levels: Chaste tree (Vitex agnus-cactus) helps normalize pituitary function and may reduce prolactin levels but must be taken for 12 - 18 months. Use under the supervision of your provider if you take hormone therapy.
• Bugleweed ( Lycopus europaeus) may also help reduce prolactin levels. Use 1 - 2 g for tea. Do not take bugleweed if you take thyroid medication.
• These herbs have estrogen-like effects and are sometimes used to counter menopausal symptoms: Black cohosh (Cimicifuga racemosa), licorice (Glycyrrhiza glabra), and squaw vine (Mitchella repens) . Do not take licorice if you have high blood pressure or heart failure.
• Other herbs that help stimulate menstrual flow include lady's mantle (Alchemilla vulgaris) andvervain (Verbena officinalis). Your doctor should monitor your liver function if you take lady's mantle.
• Kelp (Laminaria hyperborea), bladderwrack (Fucus vesiculosus), oatstraw (Avena sativa), and horsetail (Equisetum arvense) are rich in minerals that support the thyroid.
• Milk thistle (Silybum marianum) and dandelion root (Taraxacum officinale) support the liver.

Wild yam is incorrectly said to be a natural source of progesterone. Although used to produce the hormone in the laboratory, it cannot produce progesterone in the body.

Avoid blue cohosh (Caulophyllum thalictroides) . This toxic herb should not be used without strict medical supervision.

Homeopathy

Homeopathy may be useful as a supportive therapy.

Physical Medicine

The following help increase circulation and relieve pelvic congestion:

• Castor oil pack. Apply oil to a soft, clean cloth, place on abdomen, and cover with plastic wrap. Place a hot water bottle or heating pad over the pack and let sit on your abdomen for 30 - 60 minutes. You can safely use this treatment for 3 days, although it may be beneficial to use for longer; talk to your health care provider to determine the proper duration of the therapy.
• Contrast sitz baths. Use two basins that you can comfortably sit in. Sit in hot water for 3 minutes, then in cold water for 1 minute. Repeat this three times to complete one "set." Do one to two sets per day, 3 - 4 days per week.

Acupuncture

Acupuncture is believed to improve hormonal imbalances that can be associated with amenorrhea, and related conditions such as polycystic ovary syndrome (PCOS). A few small studies of women with fertility problems (which are sometimes connected with amenorrhea) suggest that acupuncture may help promote ovulation. Acupuncturists treat people with amenorrhea based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. Acupuncturists believe that amenorrhea is generally associated with liver and kidney deficiencies, and treatment often focuses on strengthening function in these areas.

Massage

Therapeutic massage may improve endocrine function by relieving stress.

Special Considerations

Becoming pregnant may be difficult or impossible. Amenorrhea also may cause pregnancy complications.

Supporting Research

Böhnert KJ. The use of Vitex agnus castus for hyperprolactinemia. Quart Rev Nat Med 1997;Spring:19-21.

Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr. 1999;69(6):1086-1107.

Chen B-Y. Acupuncture normalizes dysfunction of hypothalamic-pituitary-ovarian axis. Acupunct Electro-Therapeut Res . 1997;22:97-108.

Hutchins AM, Martini MC, Olson BA, et al. Flaxseed consumption influences endogenous hormone concentrations in post-menopausal women. Nutr Cancer. 2001;39:58-65.

Johnston CS. Recommendations for vitamin C intake. JAMA. 1999;282(22):2118-2119.

Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and recommendations for vitamin C intake. JAMA. 1999;281(15):1415-1453.

Mowrey DB. The Scientific Validation of Herbal Medicine. New Canaan, Conn: Keats Publishing; 1988.

National Institutes of Health: Accessed at http://www.nih.gov on January 16, 1999.

Sourgens H, Winterhoff H, Gumbinger HG, et al. Antihormonal effects of plant extracts; TSH- and prolactin-supressing properties of Lithospermum officianale and other plants. Planta Med. 1982;45:78-86.

Stener-Victorin E, Waldenstrom U, Andersson SA, Wikland M. Reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupuncture. Hum Reprod. 1996;11(6): 1314-1317.

Stener-Victorin E, Waldenstrom U, Tagnfors U, Lundeberg T, Lindstedt G, Janson PO. Effects of electro-acupuncture on anovulation in women with polycystic ovary syndrome. Acta Obstet Gyneol Scand. 2000;79:180-188.

Tierney LM, McPhee SJ, Papadakis MA, eds. Current Medical Diagnosis & Treatment 1999. 38th ed. Stamford, Conn: Appleton & Lange; 1999.

Tyler VE. Herbs of Choice: The Therapeutic Use of Phytomedicinals. Binghamton, NY: Pharmaceutical Products Press; 1994.

Ullman D. Discovering Homeopathy. Berkeley, Calif: North Atlantic Books; 1991.

Xiaoming M, Ding L, Yunxing P, Guifang X, Xiuzhen L, Zhimin F. Clinical studies on the mechanism for acupuncture stimulation of ovulation. J Tradit Chin Med . 1993;13(2):115-119.

• Review Date: 6/15/2006
• Reviewed By: Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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