Amenorrhea

Amenorrhea – Symptoms, Causes & Natural Treatment

Amenorrhea is the absence of menses, no menstruation cycle that produces blood flow.  It may be a primary or secondary condition.

Primary amenorrhea occurs when a girl aged 17 years or older has failed to start menstruating with or without other normal changes of puberty.

Secondary amenorrhea occurs when a woman who has been having normal menstrual cycles stops menstruating for 6 months or more (in the absence of pregnancy, breastfeeding or menopause).

Causes & Risk Factors of Amenorrhea

• Genetic or chromosomal abnormalities e.g. absence of uterus, imperforate hymen
• Tumours: of pituitary, adrenal gland or ovaries; most common is prolactinoma causing high prolactin levels
• Cervical stenosis due to chronic infection, cauterisation, cryosurgery, irradiation of cervix etc.
• Endocrine system disorders:
  • PCOS: causes failure to ovulate
  • Thyroid dysfunction: underactive thyroid increases prolactin and lowers SHBG which increases available estrogen; overactive thyroid leads to increased conversion of androgens to estrogens. Both situations can lead to ovulatory failure
  • Cushing‘s syndrome: from adrenal or pituitary tumours or corticosteroid medication
• Elevated prolactin levels: from tumours, underactive thyroid, epilepsy, prolonged stress, excessive exercise, drugs.
• Latent high prolactin levels: associated with PMS symptoms and believed to be related to an estrogen excess relative to progesterone. This leads to either an increased sensitivity to prolactin in the luteal phase, or a marginally elevated prolactin level.
• Extreme athletic training: reduces GnRH output
• < 25% body fat e.g. anorexia nervosa, malnutrition
• Some chronic diseases e.g. cystic fibrosis, chronic kidney or liver disease
• Stress: common cause of amenorrhea; reduces GnRH causing a drop in estrogen
• Obesity
• Post-OCP or contraceptive devices
• Sudden weight loss
• Certain medications e.g. chemotherapeutic agents, phenothiazides, anti-hypertensives
• Post-pill amenorrhea: most women start to menstruate within 3 months of stopping the Pill but a small percentage can experience long-term amenorrhea
• Asherman‘s syndrome: scar tissue formation following gynaecological procedures (e.g. curette) or uterine infection
• Nutritional deficiency, especially iron, B12 and folate

Investigations:

• Pelvic ultrasound: to look for presence of uterus or obstructions
• Hormonal testing:
  • High LH = possible PCOS
  • High prolactin = rule out prolactinoma, a non-cancerous tumour of the pituitary gland
  • High FSH & LH = resistant ovary syndrome

TREATMENT STRATEGY FOR AMENORRHEA

Treatment should only proceed after identifying the underlying problem. May need medical testing to rule out serious underlying causes.

• Identify underlying cause: rule out pregnancy, breastfeeding or menopause; underlying cause will determine treatment
• Assess hormonal status
• Support synthesis and metabolism of hormones
• Support ovulation (if due to low FSH / estrogen)
• Assess / support thyroid function (if indicated)
• Address nutritional deficiencies (if indicated)
• Normalise weight (if indicated)
• Support adrenal function & nervous system

TREATMENT OPTIONS FOR AMENORRHEA

Diet plan guidelines for Amenorrhea

• Unrefined, low GI whole food diet with adequate protein and healthy fats
• Minimise refined foods: deplete body of nutrients necessary for hormone production
• Limit animal products: due to exogenous estrogens
• Include phyto-estrogens e.g. fermented soy, linseeds, sprouts
• Include brassica vegetables to assist with healthy clearance of hormones from liver
• Beer should be avoided as it raises prolactin levels

Supplements that support Amenorrhea

• Support healthy hormone synthesis & metabolism
  • Zinc – indicated in relative progesterone deficiency, or for high prolactin (due to synthesis of dopamine which is a prolactin antagonist)
  • B6 –  cofactor with zinc in synthesis of dopamine and progesterone
  • Essential fatty acids – fish oils, EPO, borage oil: 1000-1500 mg/day
  • Lipotropic factors: for metabolism of hormones in liver
• Support thyroid function (if indicated)
  • Iodine: – often deficient in
  • Tyrosine:
  • Selenium:
• Address nutritional deficiencies (if indicated)
  • especially iron, B12, folate, Magnesium, Calcium , Zinc

Support nervous system

• B-complex
  • Magnesium

Herbal Medicine that supports Amenorrhea

Needs to be treated with a well-balanced formula that supports pituitary and hormone activity, as well as addressing the underlying cause.

• Female reproductive tonic – shatavari, false unicorn root, dong quai, blue cohosh, black cohosh
• Estrogen modulating – black cohosh, fennel, false unicorn root, wild yam, shatavari
• Progesterone modulating – chaste tree
• Anti-androgenic – saw palmetto, licorice & peony combination (increase rate of conversion of androgens to estrogens)
• Reduce Prolactin – chaste tree (mimics action of dopamine), licorice & peony combination
• Stimulate menstrual flow – blue cohosh, motherwort
• Nervine tonics – gotu kola, motherwort, oats, passionflower, skullcap
• Liver tonics – St Mary’s thistle, turmeric, dandelion root, rosemary

Lifestyle / Physical measures For Amenorrhea

• Stress management to reduce prolactin levels: relaxation techniques, meditation, etc
• Moderate exercise; avoid excessive exercise

FUNCTIONAL MEDICINE TREATMENT OF AMENORRHEA

Amenorrhea is a condition that sometimes affects women over the course of their life, often it can be transient of short lived and resolve itself.  If the condition continues without resolve for three months or more without reason then it is best to investigate further. 

There are many reasons that can cause fluctuating menstruation cycle, amenorrhea is commonly caused by changes in exercise habits, high stress events.  The onset can also be more gradual with multiple contributing causes such as excess weight, poor diet and lifestyle, impaired gut function, methylation issues, eating disorders and other factors influencing hormone production.

We treat females health problems such as amenorrhea at our Perth clinic of Advanced Functional Medicine as well as Australia wide via online video link. 

It you are suffering from amenorrhea or other hormonal issues we would love to hear from you.  What measures did you take to re-regulate your menstruation cycle.  Have you addressed your gut health and diet and found your menstruation improve dramatically?  Please leave a comment below.

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