Amenorrhea

5 mins read

Introduction
Amenorrhea is explained as cessation of menstrual periods in women. Amenorrhea can result because of an abnormality in the hypothalamic-pituitary-ovarian axis, anatomical abnormalities of the genital tract, or functional causes. Amenorrhea may be primary or secondary in nature.

Primary Amenorrhea
Primary amenorrhea is characterized by inability of young females to develop menstrual periods due to a genetic or anatomic condition. In individuals with primary amenorrhea, internal reproductive organs either fail to develop normally or do not function properly. Diseases of the pituitary gland and hypothalamus – important regions of brain associated with ovarian hormone production – are probable causes of primary amenorrhea.

Gonadal dysgenesis characterized by premature depletion of follicles and oocytes (egg cells), leading to premature failure of ovaries is one of the most common cases of primary amenorrhea in young women. Turner syndrome is another genetic cause wherein women lack one or both X chromosomes. Hence, lack of ovaries or estrogen production results in amenorrhea.

Secondary Amenorrhea
Pregnancy is a common cause of amenorrhea and is often found to be reason for secondary amenorrhea. Further causes may include conditions that affect ovaries, uterus, hypothalamus, or pituitary gland.

Hypothalamic amenorrhea is due to a disruption in the regulator hormones produced in hypothalamus. These hormones influence the pituitary gland to transmit signals for production of cyclic hormones to the ovaries. Disease or a tumor related to pituitary gland also creates elevation in levels of the prolactin (hormone for milk production) and cause amenorrhea. Hypothyroidism and polycystic ovary syndrome (PCOS) is also known to cause amenorrhea. Asherman’s syndrome, a uterine disease leading to scarring of the uterine lining following post-partum surgery of the uterine cavity is another cause.

Some of the natural causes of amenorrhea occur during pregnancy, breast feeding and menopause.
Women taking birth control pills usually do not get their periods. Even after stopping oral contraceptives, it can take a while for regulation of ovulation. Injectable contraceptives or intrauterine devices may also cause amenorrhea.

Lifestyle factors such as low body weight, excessive exercise and mental stress are known to be main contributors of amenorrhea.

Symptoms
Physical manifestations of Amenorrhea depend on its cause. Besides absence of periods, one may experience

  • discharge from nipples
  • hair loss
  • headache
  • changes in vision
  • facial hair
  • pelvic pain
  • acne

Diagnosis
Amenorrhea examination needs a detailed study of medical history. A physical examination, involving pelvic examination is carried out.

Further diagnostic tests are prescribed after ascertaining through the basic test criteria. Blood tests for examination of the levels of ovarian, pituitary, and thyroid hormones are undertaken. These tests generally include measurements of prolactin, follicle-stimulating hormone (FSH), estrogen and testosterone among other hormones. A pregnancy test may also be performed in some cases. In some patients, imaging studies, such as ultrasound, X-ray, and CT or MRI scanning may be recommended to learn about the root cause of amenorrhea.

Treatment
Treatment of primary and secondary amenorrhea is sought to resolve hormonal imbalance, establish menstruation or achieve fertility. Whenever genetic or anatomical abnormalities are the main causes, surgery may be recommended.

Hypothalamic amenorrhea related to weight loss and excessive exercise can be rectified by gaining weight, nutritional counseling and reducing intensity of work-out activity. Hormone therapy is recommended in cases of premature ovarian failure to avoid estrogen depletion and prevent related complications such as osteoporosis. Though postmenopausal hormone therapy is associated with certain health risks in older women, younger women with premature ovarian failure are said to benefit from this therapy to avoid bone loss.

Women with PCOS (polycystic ovary syndrome) have been found to benefit from treatments that decrease the level of androgens (male hormones).

Medications such as bromocriptine (Parlodel) can reduce elevated prolactin levels responsible for amenorrhea. Medication levels can be adjusted by the person’s physician wherever appropriate.

Women interested in pregnancy may benefit from assisted reproductive technologies and the administration of gonadotropin medications (drugs used for maturation of follicle in the ovaries) may be useful for amenorrhea patients attempting to become pregnant.

Alternative Therapy
Several herbs have been found to be useful in treating amenorrhea.

1. Angelica sinensis: This is a traditionally used herb to alleviate labor problems such as delayed birth and removal of the placenta after birth. The root of Angelica is used in relieving amenorrhea and dysmenorrhea.

2. False Unicorn: False unicorn is another traditional herb associated with infertility-curing properties.

3. Lemon Balm: This herb has historical significance in the treatment of amenorrhea and other menstrual related problems in women. It is known to promote menstrual cycle, relive menstrual cramps and also useful in amenorrhea related migraines.

4. Blue Cohosh: This herb has been documented in Ayurveda and is said to be effective uterine and menstruation stimulant. The phytochemical calulopsonin component present in herb stimulates blood flow in the pelvic region.

5. Some Of Commonly Used Spices And Herbs Such As Dill Weed, Sweet Fennel And Fenugreek Are Known To Treat Amennohea: Dill is traditionally used for enhancing the flow of breast milk. Fennel is known to stimulate menstrual cycle and also relieve premenstrual syndrome (PMS) by maintaining an optimum fluid balance in the body.  Fenugreek, widely used as vegetable or spice is known for treating lack of milk production, amenorrhea, menstrual cramps and hot flashes. Cinnamon has been traditionally used as a cure for amenorrhea along with several different ailments. Saffron known for its antioxidant content also works as a toxin-removing agent in the body. Tomato is also effective in treating amenorrhea.

Homeopathic Treatment
Pulsatilla, Senecio, Calcarea carbonica, Ferrum metallicum, Sepia and Graphites are common homeopathic drugs of choice. If menses are suppressed due to fright, Aconite, Actea spicata and Lycopodium are recommended. Advice from a homeopathic specialist is essential before taking any medication.

 

References
1. Dickerson, E. H., Raghunath, A.S. & Atkin, S. L. Initial investigation of amenorrhoea BMJ 2009; 339:b2184

2. Robinson, Angela. “Amenorrhoea.” InnovAiT: The RCGP Journal for Associates in Training 5.9 (2012): 528-540.

 

 

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