Amenorrhea is the absence of menstruation. There are two types of amenorrhea: primary and secondary. When a girl reaches age 16 and has not begun menstruating, 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. Secondary amenorrhea is more common than primary amenorrhea. Amenorrhea is a sign of another condition, not a disease itself. Many things can cause it, from low body weight to hormonal imbalances to problems with the pituitary gland. Usually the underlying condition is not serious.

Symptoms of primary amenorrhea may include:

• Headaches
• Abnormal blood pressure
• Vision problems
• Acne
• Excessive hair growth

Symptoms of secondary amenorrhea may include:

• Nausea
• Swollen breasts
• Headaches
• Vision problems
• Excessive thirst
• Goiter (an enlarged thyroid gland)
• Darkening skin

Hot flashes, mood changes, depression, and vaginal dryness are common with estrogen deficiency.

Both primary and secondary amenorrhea can have several causes.

Primary amenorrhea

• Absence of reproductive organs (such as uterus, cervix, or vagina)
• Problems with the pituitary gland
• Anorexia
• Stress
• Too much exercise
• Chromosomal abnormalities

Secondary amenorrhea

• Pregnancy or breastfeeding
• Using certain kinds of birth control
• Taking some types of medication (such as corticosteroids)
• Hormone imbalance
• Low body weight
• Too much exercise
• Thyroid disorders
• Pituitary tumor
• Stress
• Premature menopause (menopause before age 40)

Your doctor may have you take a pregnancy test, then do a physical examination, which will include an internal pelvic examination. Your doctor may also order lab tests to check your hormone levels and thyroid function. Further tests may include computerized tomography (CT) scan, magnetic resonance imaging (MRI), or ultrasound.

Your doctor will treat your condition based on the underlying cause. Treatments include hormone therapy, psychological counseling and support, and surgery, among others.

Drug Therapies

Your health care provider may suggest the following:

• Oral contraceptives (birth control pills) or hormones to cause menstruation to start.
• Estrogen replacement for low levels of estrogen caused by ovarian disorders, hysterectomy, or menopause. Women with an intact uterus should receive estrogen plus progesterone. Estrogen or hormone replacement therapy has both benefits and risks. Post-menopausal women who take hormone replacement therapy have higher incidence of breast cancer, stroke, heart disease, and blood clots in the lungs. However, for some younger women the benefits may outweigh the risks. Talk to your doctor to decide what's best for you.
• Progesterone to treat ovarian cysts and some intrauterine disorders.

Complementary and Alternative Therapies

Maintaining a proper weight and exercising the right amount can keep your body healthy. Other alternative therapies may help your body produce and use hormones properly.

Nutrition and Supplements

Eat fewer processed foods, and eat foods that are higher in unsaturated fat (but low in saturated fat). Avoid caffeine and alcohol. Eat more whole grains, vegetables, and omega-3 fatty acids (cold-water fish, nuts, and seeds). In addition, these supplements may help:

• Calcium (1,000 mg per day), magnesium (600 mg per day), vitamin D (200 - 400 IU per day), vitamin K (1 mg per day), and boron (1 to 3 mg per day). These vitamins and minerals help keep bones strong and prevent osteoporosis.
• B6 (200 mg per day) may reduce high prolactin levels. Prolactin is a hormone secreted by the pituitary gland that is often in elevated in women with amenorrhea.
• Essential fatty acids: Evening primrose or borage oil (1,000 - 1,500 mg one to two times per day).

Progesterone is sometimes available as an over-the-counter oral supplement. However, this hormone that should never be taken without your doctor's supervision.

Herbs

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 amenorrhea, but have been used traditionally. Many have an estrogen-like effect. 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.

• For high prolactin levels: Chaste tree (Vitex agnus-castus) helps normalize pituitary function and may reduce prolactin levels but must be taken for 12 - 18 months. One very small study found that 10 of 15 women with amenorrhea started having periods after taking chaste tree for 6 months. If you already use hormone therapy, do not use chaste tree except under your doctor's supervision.
• These herbs have estrogen-like effects and are sometimes used to treat menopausal symptoms, although scientific evidence is mostly lacking: Black cohosh (Cimicifuga racemosa), licorice (Glycyrrhiza glabra), and squaw vine (Mitchella repens). Do not take licorice if you have high blood pressure or heart failure.
• Other herbs that help stimulate menstrual flow include lady's mantle (Alchemilla vulgaris) and vervain (Verbena officinalis). Your doctor should monitor your liver function if you take lady's mantle.
• Kelp (Laminaria hyperborea), oatstraw (Avena sativa), and horsetail (Equisetum arvense) are rich in minerals that may help promote thyroid function.

Wild yam is sometimes said to be a natural source of progesterone, but that is not true. Although it was once used to produce the hormone in the laboratory, the body cannot make progesterone from wild yam.

Avoid blue cohosh (Caulophyllum thalictroides). This toxic herb should not be used without strict medical supervision.

Homeopathy

Homeopathy may be useful as a supportive therapy.

Physical Medicine

The following help increase circulation and relieve pelvic congestion:

• Castor oil pack. Apply oil to a soft, clean cloth, place on abdomen, and cover with plastic wrap. Place a hot water bottle or heating pad over the pack and let sit on your abdomen for 30 - 60 minutes. You can safely use this treatment for 3 days, although it may be beneficial to use for longer; talk to your health care provider to determine how long to use it.
• Contrast sitz baths. Use two basins that you can comfortably sit in. Sit in hot water for 3 minutes, then in cold water for 1 minute. Repeat this three times to complete one "set." Do one to two sets per day, 3 - 4 days per week.

Acupuncture

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.

Becoming pregnant may be difficult or impossible. Amenorrhea also may cause pregnancy complications.

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