Amenorrhea

Amenorrhea refers to the absence of menstruation and is of two types: primary amenorrhea, in which menstruation has not begun by late puberty, even if other signs of physical maturation are present; and secondary amenorrhea, which is the cessation of menstruation for more than 3 cycles in a post-pubescent woman. There are many possible causes of amenorrhea, including:

• intrauterine adhesions
• cervical stenosis
• obstruction of menstrual flow
• hypothalamic dysfunction
• GnRH inhibition
• weight loss
  
• rigorous exercise
• severe chronic illness
• drugs such as the phenothiazines (antiemetics), antihypertensives and antipsychotics
• after using oral contraceptives
• polycystic ovarian disease
• breast feeding
• hypothyroid conditions (leads to decreased SHBG and thus increased estrogen)
• hyperthyroid (conversion of androgens to estrogens)
• excessive glucocorticoids (e.g. Cushing's syndrome)
• premature ovarian failure (perhaps an autoimmune disease?)
• ovarian damage or destruction (from ischemia) (Trickey 1998, 209-212; Berkow 1992, 1798, 1802)

The most common causes of amenorrhea are hyperprolactinemia, and a relative androgen excess. Hyperprolactinemia is a condition in which there are increased levels of prolactin in the bloodstream. The signs and symptoms include galactorrhea (breast milk production), menstrual irregularities, decreased GnRH and LH levels, elevated androgens (with decreased 5-alpha-reductase activity), decreased SHBG, and decreased bone density. Possible causes of hyperprolactinemia include pituitary tumors, hypothyroidism, prolonged stress, excessive breast stimulation (Chinese "Deer" exercises), excessive exercise, drugs (phenothiazines, dopamine antagonists, antihypertensives, antiulcer drugs, estrogen oral contraceptives, opiates, cocaine) and alcohol (especially beer because of the Hops, which is a galactagogue). (Trickey 1998, 213-216)

The primary treatment of hyperprolactinemia involves the usage of progesterogenic botanicals such as Chasteberry (Vitex agnus castus) that has a dopaminergic activity, and other herbs to support the hypothalamic-pituitary axis such as Peony root (Paeonia lactiflora), Rehmannia (Rehmannia glutinosa), and Licorice root (Glycyrrhiza glabra). The supplementation of zinc and vitamin B6 are useful as both are cofactors in dopamine synthesis and can be included in the treatment. Important also is weeding through the various medications that could be causing this condition, as well as eliminating alcohol from the diet. Other lifestyle regimens that need to be addressed are stress management skills and physical exercise.

Androgen excess is another possible cause of amenorrhea, and describes a condition in which there are higher than normal levels of circulating androgens. Possible causes include PCOD (polycystic ovarian disease), an androgen-secreting adenocarcinoma of the adrenal gland, adrenal hyperplasia, steroidal drugs (synthetic progesterone, cortisone), post-menopause, and obesity. The signs and symptoms of androgenization include hirsutism, alopecia, acne, and elevated blood pressure. Other, more rare symptoms include the deepening of the voice, clitoral enlargement, and decreased breast size. Laboratory evidence will typically show elevated serum testosterone and DHEA. Some cases of androgenization are the result of an increased sensitivity to androgens rather than an androgen excess, and thus will not show up with lab tests. (Trickey 1998, 217-219; Berkow 1992, 1800)

The treatment of androgenization is difficult, and the primary thrust of the treatment is symptomatic, with the attention being placed upon the cause or causes. Important botanicals are those that nurture and enhance the "feminine essence" such as Peony root (Paeonia lactiflora) and Licorice (Glycyrrhiza glabra), both of which have been shown increase the enzymatic conversion of testosterone to less potent androgens. Phytoestrogens too, such as Red Clover blossoms (Trifolium pratense), True Unicorn root (Aletris farinosa), and Black Cohosh (Cimicifuga racemosa) are important as they increase the levels of SHBG that deactivate androgens. Especially important are herbs that have the ability to competitively inhibit androgenic activity, such as Damiana (Turnera diffusa), Saw Palmetto (Serenoa serrulata), and Sarsaparilla (Smilax spp.). In regard to diet, animal products and saturated fat should be decreased, replaced by increasing fiber, fermented legumes, and whole foods. Additionally, the importance of treating obesity should not be underestimated. This treatment of this condition is truly a challenge, complexed with the fact that herbal therapies are slow to take effect in established syndromes.