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.
Signs and Symptoms
Symptoms sometimes related to primary amenorrhea include headaches, abnormal
blood pressure, vision problems, acne, excessive hair growth, and perhaps either
a short, stubby physique or extremely tall stature.
Symptoms sometimes related to secondary amenorrhea include nausea, swollen
breasts, headaches, vision problems, unusual thirst, goiter (an enlarged thyroid
gland), skin darkening, extreme weight loss, alcoholism, liver disease, and
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
Developmental problems, such as the absence of the uterus or
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 mellitus or tuberculosis)
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.
Your healthcare provider will treat your condition based on the underlying
cause. Treatments include hormone therapy, psychological counseling and support,
and surgery among others.
Your provider may suggest the following drugs:
Oral contraceptives or hormones to cause menstruation to
Estrogen replacement for low levels of estrogen caused by ovarian
disorders, hysterectomy, or menopause; greatly reduces risk of cardiovascular
disease and inhibits osteoporosis; conjugated estrogens 0.625 to 1.25 mg per
day; or on days 1 to 25 of calendar month (0.3 mg per day prevents bone loss).
Women with an intact uterus should receive progestin (medroxyprogesterone
acetate (MPA), a progestin, is given 5 to 10 mg per day on days 16 to 25 of
calendar month to reduce risk of estrogen-induced endometrial cancer)
Progesterone to treat ovarian cysts and some intrauterine
Alternative estrogen replacement: includes ethinyl estradiol (20 or
50 mcg); estradiol (0.5, 1, 2 mg); Selective Estrogen Receptor Modulators
(SERMs) such as raloxifene if individual refuses estrogen but is at-risk for
Complementary and Alternative Therapies
Alternative therapies may help the body metabolize hormones while ensuring
that the nutritional requirements for hormone production are met.
Eat fewer refined 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
Iodine (up to 600 mcg per day), tyrosine (200 mg one to two times 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).
B6 (200 mg per day) may reduce high prolactin levels.
Essential fatty acids: Flaxseed, evening primrose, or borage oil
(1,000 to 1,500 mg one to two times per
Herbs may be used as dried extracts (capsules, powders, teas), glycerites
(glycerine extracts), or tinctures (alcohol extracts). Unless otherwise
indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep
covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots.
Drink 2 to 4 cups per day.
Chaste tree (Vitex agnus-cactus) helps normalize pituitary
function but must be taken for 12 to 18 months. Use under the supervision of
your provider if you take hormone therapy.
Black cohosh (Cimicifuga racemosa), licorice (Glycyrrhiza
glabra), and squaw vine (Mitchella repens) help to balance estrogen
levels. Do not take licorice if you have high blood pressure.
Chaste tree, wild yam (Dioscorea villosa), and lady's mantle
(Alchemilla vulgaris) help balance progesterone levels.
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), dandelion root (Taraxacum
officinale), and vervain (Verbena officinalis) support the
Homeopathy may be useful as a supportive therapy.
The following help increase circulation and relieve pelvic
Castor oil pack. Apply oil to skin of abdomen, cover with a clean soft
cloth and plastic wrap. Place a hot water bottle or heating pad over the pack
and let sit for 30 to 60 minutes. Use for three days.
Contrast sitz baths. Use two basins that you can comfortably sit in.
Sit in hot water for three minutes, then in cold water for one minute. Repeat
this three times to complete one "set." Do one to two sets per day, three to
four days per week.
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.
Therapeutic massage may improve endocrine function by relieving
Becoming pregnant may be difficult or impossible. Amenorrhea also may cause
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Review Date: August 1999
Reviewed By: Participants in the review process include: Dahlia Hirsch, MD, Center for
Holistic Healing, BelAir, MD; Pamela Stratton, MD, Chief, Gynecology Consult
Service, National Institute of Child Health and Human Development, National
Institutes of Health, Bethesda, MD; Marcellus Walker, MD, LAc, (Acupuncture
section October 2001) St. Vincent's Catholic Medical Center, New York, NY;
Leonard Wisneski, MD, FACP, George Washington University, Rockville, MD; Ira
Zunin, MD, MPH, MBA, (Acupuncture section October 2001) President and Chairman,
Hawaii State Consortium for Integrative Medicine, Honolulu,
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