Amenorrhea means not menstruating or having a period. There are two types of amenorrhea: primary and secondary. When a girl reaches age 16 and has not had a period, she may have primary amenorrhea. When a woman who has been having periods misses three in a row, she is considered to have secondary amenorrhea. Amenorrhea is expected in certain circumstances, including during pregnancy, lactation, and menopause. Secondary amenorrhea is more common than primary amenorrhea.
Amenorrhea is a sign of another condition, not a disease itself. Many things can cause it, including low body weight, hormonal imbalances, stress, and problems with the pituitary gland. Usually, the underlying condition is not serious.
Signs and Symptoms
Symptoms of primary amenorrhea may include:
Symptoms of secondary amenorrhea may include:
Hot flashes, mood changes, depression, and vaginal dryness are common with estrogen deficiency.
What Causes It?
Both primary and secondary amenorrhea can have several causes.
What to Expect at Your Provider's Office
Your doctor may ask you to take a pregnancy test, then do a physical exam, which will include an internal pelvic exam. Your doctor may also order lab tests to check your hormone levels and to learn how well your thyroid is working. Other tests may include computerized tomography (CT) scan, magnetic resonance imaging (MRI), or ultrasound.
Your doctor will determine which treatment is right for you based on the cause of your amenorrhea. Treatments include hormone therapy, psychological counseling and support, and surgery, among others.
Your health care provider may suggest the following:
Complementary and Alternative Therapies
Maintaining a healthy weight and exercising regularly can keep your body healthy. Other alternative therapies may help your body make and use hormones properly.
Nutrition and Supplements
Be sure to eat a healthy diet. Limit processed foods, and eat foods with heart-healthy fats (unsaturated fats) rather than saturated fats. Avoid caffeine and alcohol. Eat more whole grains, vegetables, and omega-3 fatty acids found in cold-water fish, nuts, and seeds. Diets that are very low in fat can raise your risk of amenorrhea. In addition, these supplements may help:
Progesterone is sometimes available as an over-the-counter oral supplement. However, you should never take progesterone without your doctor's supervision.
The use of herbs is a time-honored approach to strengthening the body and treating disease. Herbs, however, can trigger side effects and can interact with other herbs, supplements, or medications. For these reasons, take herbs only under the supervision of a health care provider.
Most of the herbs listed below have not been studied specifically for treatment of amenorrhea, but they have been used traditionally. Many act like the hormone estrogen in the body. Talk to your doctor before taking them, and avoid these herbs if you have a history or family history of cancers associated with estrogen, including breast, cervical, uterine, and ovarian cancer.
The following herbs have estrogen-like effects and are sometimes used to treat menopausal symptoms, although there are no clinical trials that show whether they work or are safe:
DO NOT take the herb blue cohosh (Caulophyllum thalictroides). This toxic herb should not be used without strict medical supervision.
Few studies have examined the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend treatments for amenorrhea based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type, which is your physical, emotional, and intellectual makeup.
The following help increase circulation and relieve pain from pelvic congestion:
Acupuncture may improve hormonal imbalances that can go along 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 often associated with liver and kidney deficiencies, and treatment often focuses on strengthening function in these areas.
Becoming pregnant may be difficult or impossible. Amenorrhea also may cause pregnancy complications.
Amenorrhea can also raise the risk of developing osteoporosis.
Bope ET, Kellerman RD, eds. Conn's Current Therapy 2013. 1st ed. Philadelphia, PA: Elsevier Saunders; 2012.
Böhnert KJ. The use of Vitex agnus castus for hyperprolactinemia. Quart Rev Nat Med 1997;Spring:19-21.
Bruni V, Dei M, MOrelli C, Schettino MT, Balzi D, Nuvolone D. Body composition variables and leptin levels in functional hypothalamic amenorrhea and amenorrhea related to eating disorders. J Pediatr Adolesc Gynecol. 2011;24(6):347-52.
Cardigno P. Homeopathy for the treatment of menstrual irregularities: a case series. Homeopathy. 2009 Apr;98(2):97-106.
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.
Feldmann JM, Belsha JP, Elissa MA, Middleman AB. Female adolescent athletes' awareness of the connection between menstrual status and bone health. J Pediatr Adolesc Gynecol. 2011; 24(5):311-4.
Frederick CE, Edelman A, Carlson NE, Rosenberg KD, Jensen JT. Extended-use oral contraceptives and medically induced amenorrhea: attitudes, knowledge and prescribing habits of physicians. Contraception. 2011;84(4):384-9.
Gabel KA. Special nutritional concerns for the female athlete. Curr Sports Med Rep. 2006 Jun;5(4):187-91. Review.
Heiss G, Wallace R, Anderson GL, Aragaki A, Beresford SA, Brzyski R, et al; WHI Investigators. Health risks and benefits 3 years after stopping randomized treatment with estrogen and progestin. JAMA. 2008 Mar 5;299(9):1036-45.
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, CT: Keats Publishing; 1988.
Rakel. Textbook of Family Medicine. 8th ed. Philadelphia, PA: Elsevier Saunders; 2011.
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.
Tyler VE. Herbs of Choice: The Therapeutic Use of Phytomedicinals. Binghamton, NY: Pharmaceutical Products Press; 1994.
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: 11/14/2013
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
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