Amenorrhea

What is it?

Amenorrhea is when there is no menstrual bleed or period for at least 6 months.

Causes

• Pregnancy and/or breastfeeding
• Body fat too low: this decreases Gonadotropin Releasing Hormone (GnRH) so there is no hypothalamic feedback between the brain (pituitary and hypothalamus), ovaries and uterus.
• Stress: the excess secretion of cortisol decreases GnRH and increases Prolactin in the pituitary. Severe anxiety and depression as well as jetlag may inhibit or delay ovulation and your periods. Changes in season, a lack of exposure to natural light, diet, travel, during family stress particularly can all change your period patterns.
• Polycystic Ovarian Syndrome PCOS: hormonal imbalance causing multiple cysts on the ovary and inhibition of ovulation.
• Insulin Resistance: blood sugar imbalances causing insulin resistance interferes with ovulation causing a lack of or irregular periods.
• Hypothyroidism: Low thyroid function must be ruled out.
• Excessive exercise is a form of physical stress on the body and releases large amounts of cortisol and adrenaline which interferes with hormones.
• Poor nutrition: if the body simply does not have the nutrients to sustain menstrual and hormonal health. Normally this would occur in conjunction with a very low body weight, anorexia or bulimia. Even a radical change in diet can alter your hormones.
• Pituitary tumours: the pituitary produces excessive amounts of Prolactin which inhibits ovulation and periods.
• Long term use of Oral Contraceptive Pill: the ovary remains dormant and needs extra stimulation to reactivate. If there is poor liver function, residues of the high synthetic hormones from the Pill remain in  the liver and may continue to inhibit ovulation.
• Menopause or Premature Ovarian Failure: the ovary’s function declines so hormone levels decrease.
• Medications and Drugs: Amphetamines, neuroleptics, excessive caffeine, nicotine, steroids can all inhibit ovulation.

Diagnosis:

It is important to identify the underlying cause of the absent periods and rule out causes other than a hormonal imbalance so the following tests are recommended with your doctor:

      Oestradiol, FSH, LH, Progesterone

      Prolactin, TSH, Testosterone, Free Testosterone

      SHBG, FAI, DHEAS,

      1 & 2 hour GTT with Insulin

      LFT, Ferritin, Folate, Vitamin B12, CRP

      Internal Ultrasound

Long Term Complications:

·         Irregular and anovulatory menstrual cycles are associated with premature bone loss and increase the risk of osteoporosis so it is essential that Calcium with Vitamin D is supplemented and these are also tested via a blood test. A bone density scan may also be necessary.

·         Endometrial hyperplasia and uterine cancer: increased cell proliferation or thickening of the uterus lining if there is unopposed oestrogens. A woman must have a minimum of 5-6 menstrual periods per year or if she is over 35 years of age, a period almost monthly.

·         Shrinkage of the ovaries and thinning of the lining of the uterus as there is no hormonal stimulation

·         Heart disease: a lack of oestrogen increases the risks of cardiovascular disease, hypertension, heart attack and atherosclerosis.

·         Infertility: decreased fertilization potential due to lack of ovulation

Orthodox Medical Treatment

·         The Oral Contraceptive Pill is given to “regulate” the periods and ensure there are enough circulating hormones but they do not deal with the underlying cause, simply masking it. The Pill must be given if there is insulin resistance as it will exacerbate it. According to Dr Kidson, leading Australian endocrinologist, if a woman is insulin resistant, the Pill could be expected to increase the risk of diabetes by at least 100% and possible by 200%. OCP’s “may completely turn off the fertility clock in women with clock problems, so that ovulation and menstruation do not occur when the pill is stopped” (Kidson). The Pill must also not be given if the woman smokes due to the increased risk of blood clots and stroke.

·         Progestogens: Provera and Primolut N: given in the 2^nd half of the cycle on day 14-28 for 3 months to try and trigger a menstrual cycle; side effects of nausea, bloating, acne, breast tenderness, weight gain, mood changes, increased facial and body hair, deepening voice related to the androgenising (male hormone) effects of the drugs, abnormal cholesterol ratios. Primolut N and the norethisterones must only be used for no more than 6-12 months.

·         If pregnancy is desired, Clomiphene citrate (Clomid/Serophene) or Human Menopausal Gonadotropin (Metrodin, Humegon, Perganol, Fertinex) is given to induce ovulation. These drugs have side effects and risks, eg. Clomiphene can cause ovarian enlargement; ovaries become resistant over time; can lead to ovarian hyperstimulation, causing permanent ovarian damage; increases the risk of ovarian cancer by 3 times if taken longer than 1 year, increases the chance of multiple and ectopic pregnancy; increases risk of vascular and pulmonary complications; increases risks of birth defects by 6 times; thins the lining of the uterus which decreases implantation rates for fertility.

Naturopathic Perspective

Treatment length for Amenorrhea usually requires 3-12 months, depending on how long there have been absent periods and the underlying cause. Dietary and lifestyle changes are essential for successful treatment as well as some introspection into the emotional contributing factors. Extensive information and resources are given to help you alter your diet to healthier options. Treatment includes weight management, exercise, stress reduction techniques, dietary advice, nutritional supplements and herbal medicines. Investigation into the underlying cause is necessary to ensure correct treatment.

Hormonal regulation is achieved using specific herbal medicines and nutritional supplements which are individually prescribed to:

• Balance hormones to improve oestrogen production and stimulate ovulation.
• Ensure regular menstrual cycles, normal menstrual flow and uterine function
• Ensure adequate calcium levels
• Calm and nourish the nervous system

Using the work of Christiane Northrup, author of Women’s Bodies Women’s Wisdom, the emotional connections to Amenorrhea are discussed to address any underlying issues.

Claudette Wadsworth
BA, BHlthSc, AdvND, DN, DRM, AdvNFM, MATMS
Bondi Junction.