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DESCRIPTION
TYPES OF AMENORRHEA
Amenorrhea is the absence of the menstrual period. There are 2 types of amenorrhea:
- Primary Amenorrhea: Refers to the situation when a young women has not begun to menstruate by the age of 16. Primary amenorrhea is when the woman has never had a period in her life. This condition is rare and causes are quite different from secondary amenorrhea.
- Secondary Amenorrhea: Refers to the situation when a woman who previously experienced menstrual periods suddenly ceases to have them. Secondary amenorrhea is defined as the cessation of menstruation for at least 3 months in a woman who has previously menstruated. In women who have had regular menstrual periods, it is an absence of menstruation for 6 months and for women who had irregular periods, it is a absence of menstruation for a period of 12 months. This problem is seen in about 1 percent of women of reproductive age. The incidence of secondary amenorrhea (due to some cause than pregnancy) is about 4 percent in the general population.
FREQUENT SIGNS & SYMPTOMS
Absence of menstrual periods for 3 to 6 or more months in a woman who has menstruated at least once.
Note: Other symptoms associated with amenorrhea depend on the cause. They may include:
- Headache.
- Galactorrhea (breasts producing secretions / milk) in a woman who is not pregnant or breastfeeding an infant).
- Marked, weight gain or rapid weight loss with low concentration of body fat.
- Dry vagina.
- Increased hair growth (such as facial hair) in a "male pattern" (hirsutism).
- Voice changes (deeper voice).
- Breast size changes.
- Decreased armpit hair & pubic hair.
If amenorrhea is caused by a pituitary tumor, other symptoms related to the tumor such as visual loss, may be present.
CAUSES
NORMAL CAUSES OF AMENORRHEA
Pregnancy (if a woman has had sexual intercourse). This is the most common cause of secondary amenorrhea in reproductive age women. This should always be excluded by a physical exam and laboratory testing for the pregnancy hormone HCG. Secondary amenorrhea, while pregnant, is a normal condition that needs no medical attention.
Breastfeeding an infant. Secondary amenorrhea, while breastfeeding your baby, is a normal condition and does not need any medical attention.
Menopause (if a woman is over 35 and not pregnant). Secondary amenorrhea occurs naturally in menopausal women and usually does not need any medical attention. Menopause is normal for women over age 45. Early appearance of menopause may account for some cases of amenorrhea.
ABNORMAL CAUSES OF AMENORRHEA
Amenorrhea can be the sign of a serious disorder of the endocrine system including the pituitary, hypothalamus, thyroid, parathyroid, adrenal and ovarian glands. Both Cushing's disease (over activity of adrenal glands) and hypothyroidism (under-functioning thyroid gland) can cause amenorrhea.
If the patient has a history of severe postpartum hemorrhage (very heavy bleeding after a delivery), she may have pituitary insufficiency from infarction (Sheehan's syndrome).
When amenorrhea follows a D&C (dilation and curettage) one should suspect intrauterine adhesions (Asherman's syndrome), particularly if the procedure was pregnancy related. The procedure can cause a woman to develop amenorrhea if scar tissue develops within the uterine cavity.
Asherman's can also occasionally be seen following other types of uterine surgery such as metroplasty, myomectomy or cesarean section. The procedure can cause a woman to develop amenorrhea if scar tissue develops within the uterine cavity.
Amenorrhea following cervical conization can be due to procedure related cervical stenosis.
Discontinuing use of birth-control pills or other hormonal contraception or therapy. Following discontinuation of oral contraception some women will not have periods for up to several months. However, the reported incidence for amenorrhea lasting more than 6 months after the pill is stopped is 0.8 percent which is essentially the same as the incidence of amenorrhea in the general population. Therefore, amenorrhea of greater than 6 months duration after oral contraceptive use is not related to the pill use. Non-oral contraceptives such as Norplant and Depo-Provera, can all cause scanty or missed menstrual periods.
Emotional stress or psychological disorder. Anxiety over a possible pregnancy may cause a missed period, thereby increasing the anxiety even further. Emotional distress from other causes can also caused missed menstrual periods.
Surgical removal of the ovaries or uterus.
Drugs such as bufulfan, chlorambucil, cyclophosphamide, and phenothiazines can all cause scanty or missed menstrual periods.
Diabetes mellitus.
Tuberculosis.
Amenorrhea is associated with malnutrition. Eating disorders, such as Obesity, anorexia nervosa or bulimia. A large amount of weight loss or gain can also lead to anovulation. Body fat content less than 15 to 17 percent in women will often result in menstruation cessation.
Strenuous program of physical exercise, such as long distance running. A large amount of extensive exercise and/or can also lead to anovulation. Excessive exercise puts extreme nutritional demands on the body. Many women athletes experience secondary amenorrhea during training, especially without adequate conditioning. Body fat content less than 15 to 17 percent in women will often result in menstruation cessation.
RISK INCREASES WITH
Stress.
Use of drugs, including oral contraceptives and hormones, phenothiazines, barbiturates, narcotics, and reserpine.
Excessive exercise.
PREVENTIVE MEASURES
If your amenorrhea is cause by an underlying disease, such as tuberculosis, hormonal imbalance, diabetes, or anorexia nervosa, obtain treatment for the primary disorder.
If the cause of your amenorrhea is unknown, there are no specific preventive measures.
Maintain proper nutrition & body weight.
Moderate exercise instead of extreme exercise may be helpful.
Avoid stress.
Get plenty of sleep.
Smoking and substance abuse have been linked to amenorrhea, so avoid tobacco products and other stimulants or drugs.
EXPECTED OUTCOME
Amenorrhea is not, in itself, a threat to health. Whether it can be corrected varies with the underlying cause. Most of the conditions that cause secondary amenorrhea will respond to treatment:
- If from pregnancy or breast-feeding, menstruation will resume when these conditions cease.
- If from discontinuing use of oral contraceptives, other hormone contraceptives or hormonal therapies, periods should begin in 2 months to 2 years.
- If from menopause, periods will become less frequent or may never resume.
- Hysterectomy also ends menstruation permanently.
- If from endocrine disorders, hormone replacement therapy usually causes periods to resume.
- If from eating disorders, successful treatment of that disorder is necessary for menstruation to resume.
- If from diabetes or tuberculosis, menstruation may never resume.
- If from strenuous exercise, periods usually resume when exercise decreases.
POSSIBLE COMPLICATIONS
None expected if no serious underlying cause can be discovered. Secondary amenorrhea, in itself, does not cause complications. However, the conditions that cause amenorrhea may have complications.
May experience estrogen deficiency symptoms, such as hot flashes, vaginal dryness.
May affect fertility.
TREATMENT
GENERAL MEASURES
Diagnosis and treatment depends on the cause of the amenorrhea. If it is caused by another systematic disorder, normal menstrual function usually returns after the primary disorder is treated.
DIAGNOSIS
A good health history can reveal the etiologic diagnosis in up to 85 percent of cases. A detailed menstrual history should be taken.
To aid in diagnosis, laboratory studies, such as pregnancy test, blood studies of hormone levels (progestin, prolactin, testosterone, FSH-follicle stimulating hormone, LH-Luteinizing hormone, TSH-thyroid stimulating hormone and other thyroid function tests may be done. Karyotype to rule out the presence of Y chromosome abnormality. A Pap smear usually necessary. Radiological tests may be done to aid in diagnosis. A CT scan of the head may be done if a pituitary tumor is suspected. Surgical diagnostic procedures, such as laparoscopy or hysteroscopy may be recommended.
During the physical exam your health care provider will be looking for certain things, such as:
- Signs of androgen excess such as hirsutism (excess hair growth) and clitoromegaly (enlargement of the clitoris).
- The breast exam may reveal galactorrhea.
- Estrogen deficiency may be suggested on pelvic exam by a smooth vagina that lacks the normal rugae (wrinkles) and a dry endocervix with no mucus.
TREATMENT
Dilation and curettage, often referred to as a D&C (dilation of the cervix and a scraping out of the uterus with a curette) may be performed.
Secondary amenorrhea is a symptom that can be caused by many pathological states. Treatment of the underlying disorder if one is diagnosed. Some women will not demonstrate any obvious reasons for their amenorrhea on history and physical exam. These women can be worked up in a logical manner using a stepwise approach. Diagnostic approaches may vary, however, differences between them pertain mainly to the order in which tests are performed.The first tests usually used include after pregnancy is ruled out are a progesterone withdrawal test as well as a TSH (thyroid stimulating hormone) and prolactin level.
- Thyroid Function: Both hypothyroidism and hyperprolactinemia can cause primary or secondary amenorrhea. If these entities are discovered, appropriate therapy should result in resumption of regular menstrual periods. If the amenorrhea is caused by hypothyroidism, as an example, then it will be remedied when the thyroid disorder is treated with thyroid supplements.
MoonDragon's Health & Wellness: Hypothyroidism
- Progestational Challenge (Progesterone Withdrawal Test): The progestational challenge test is performed by giving oral medroxyprogesterone acetate 10 mg daily for 7-10 days or progesterone in oil 100-200 mg intramuscularly. A positive response is any bleeding more than light spotting that occurs within 2 weeks after the progestin is given. This bleeding will usually occur 2-7 days after the progestin is finished. Withdrawal bleeding will usually be seen if the woman's estradiol level is 40 pg/ml or more. If the woman experiences bleeding after the progestin she has estrogen present but is not ovulating. If no withdrawal bleeding occurs, either she has very low estrogen levels or there is a problem with the outflow tract such as uterine synechiae (adhesions) or cervical stenosis (scarring).
- Women With Withdrawal Bleeding: Your health care provider may first consider the diagnostic evaluation of the woman with withdrawal bleeding and normal prolactin and TSH levels. The basic diagnosis at this point is anovulation for which there are many causes. If there is a history of recent stress, weight loss, medications or street drugs, these factors could be causing the amenorrhea. Some experts believe that an LH and FSH level may be helpful at this point. If the LH is high (above about 10 MIU/ml) and the LH/FSH ratio is above 2:1, this supports the clinical diagnosis of polycystic ovarian disease (PCO). However, many women with PCO do not demonstrate this high LH/FSH ratio. Testosterone and DHEAS levels may be useful in women with PCO, especially in the presence of hirsutism or other signs of hyperandrogenism (excess male hormones). Chronic anovulation should be managed by periodic progestin withdrawal, or oral contraceptive pills if the woman does not desire pregnancy at this time. If she desires pregnancy, induction of ovulation with clomiphene citrate or injectable gonadotropins can be discussed. If the anovulatory state has been longstanding, one should consider endometrial biopsy to rule out significant hyperplasia or carcinoma of the endometrium.
- Women Without Withdrawal Bleeding: The health care provider will consider the evaluation of women who do not have withdrawal bleeding after the progestin challenge. These women have either a hypoestrogenic state or a compromised outflow tract. There are 2 ways to approach the next step.
1. One way is to use hormone therapy by giving estrogen to ensure endometrial proliferation, followed by a progestin to induce withdrawal. A course of 2.5 mg of Premarin for 21 days including 10 mg of Provera on days 17-21 will be adequate. If bleeding occurs, her amenorrhea is due to hypoestrogenism. If bleeding does not occur, then the woman most likely has outflow tract obstruction - either Asherman's syndrome or cervical stenosis.
2. The other approach is to perform an FSH level. If the level is high (above 30-40 MIU/ml), the woman has premature ovarian failure (see below) and does not need the estrogen and progestin challenge. If the FSH is normal, it is still a good idea to proceed with the course of estrogen and progestin as described above.
The next step in the women that do not bleed after the combined hormonal regimen is either hysterosalpingography or hysteroscopy. If adhesions are found, they should be hysteroscopically lysed if the patient is desirous of pregnancy or menses.
Intrauterine adhesions are rare in the absence of a history of pelvic infection or curettage. Therefore, if the pelvic exam is normal and the history is not consistent with development of adhesions, consideration can be given to skipping the estrogen-progestin step.
- FSH Testing: If the woman did bleed after the combined hormonal regimen (or if that step was skipped) the next test to obtain is an FSH level. This should not be drawn for at least 2 weeks after the estrogen-progestin regimen is completed so that the level is not affected by the exogenous estrogen. If the FSH is greater than 30-40 MIU/ml, the woman almost certainly has ovarian failure. Mid-cycle FSH peak levels in ovulatory cycles should not be this high. FSH levels that are in the menopausal range should be checked at least once again in about 4 weeks. An estradiol level can be checked as well for further confirmation. With ovarian failure, the estrogen level will be low (usually less than 20-30 pg/ml).
- Ovarian Failure (Premature Menopause): Once ovarian failure is confirmed consideration should be given to 2 special etiologic situations. If the woman is under 30, a karyotype should be performed to rule out any mosaicism involving a Y chromosome. This is important because of the high risk (about 25 percent) for a gonadal malignancy developing if there is any testicular tissue present. If a Y chromosome is found the gonads should be surgically excised. These tumors apparently do not appear after age 30 so that karyotypic analysis is then no longer necessary. Other chromosomal anomalies will occasionally be found. These are usually either 45X (Turner's syndrome) or some variation of Turner's mosaic.
The other special category of premature ovarian failure is that associated with autoimmune disease. These women have autoimmune related dysfunction of other endocrine organs. The most common association is with thyroid disease, but the parathyroids and adrenals can also be affected. Therefore, it is prudent to screen for these conditions. Thyroid function tests and thyroid antibody levels should be obtained. A morning cortisol level or a corticotropin (ACTH) stimulation test assesses adrenal reserve. Serum calcium, phosphate and protein levels are ordered to evaluate possible hypoparathyroidism. A CBC with differential, sedimentation rate, anti-nuclear antibody and rheumatoid factor may be useful in further assessing any possible autoimmune dysfunction.
Laboratory evidence of autoimmune phenomenon is much more prevalent than clinically significant disease. Several studies have shown laboratory evidence of immune problems in about 15-40 percent of women with premature ovarian failure. Thyroid and Lupus-related antibodies are most commonly found. It is presently unknown as to what the incidence of clinically apparent autoimmune disease will be in these women when followed over time. Women with well documented premature ovarian failure should be placed on estrogen/progestin replacement therapy if there are no contraindications. This will provide some protection against osteoporosis and cardiovascular disease by eliminating the severely hypoestrogenic state associated with menopause. Regardless of the etiology, there currently is no effective treatment that will be likely to result in a pregnancy (with her own eggs) for premature ovarian failure. However, some women will spontaneously ovulate on occasion and pregnancy can occur although it is unusual. Those pregnancies that do occur are almost always in women on estrogen replacement therapy. These women should be educated about this possibility.
Egg donation with in vitro fertilization (IVF) can be a very effective therapy for women with premature ovarian failure that desire pregnancy.
In general, ovarian biopsy is not indicated in patients with premature ovarian failure since no clinically useful information will be obtained.
- Hypothalamic-Pituitary Failure: Women who do not bleed after the progestin challenge but do after estrogen/progestin and have normal or low FSH and LH levels make up the final group to be discussed. These women have hypothalamic-pituitary failure. Some medications (e.g. phenothiazines) as well as extremes of weight loss, stress or exercise can cause this type of secondary amenorrhea. A pituitary or hypothalamic tumor would be a rare finding in women who were all screened with prolactin levels at the beginning of the diagnostic evaluation. However, if there is no cause apparent from the history, it would be prudent to obtain a baseline CT (or MRI) evaluation of the sellar region to rule out a space occupying lesion.
Women with normal prolactin levels and normal imaging studies have hypothalamic amenorrhea of uncertain etiology. If the amenorrhea and lack of withdrawal bleeding persists, prolactin levels should be measured annually since a small microadenoma could be present that is escaping laboratory and radiographic detection.
women can be significantly hypoestrogenic (a low estrogen situation similar to menopause). If the state is persistent, hormone replacement therapy should be considered for protection against osteoporosis. One approach is to get an estradiol level and if it is less than 30 pg/ml, counsel the patient that hormonal replacement therapy is indicated.
Psychotherapy or counseling, if amenorrhea is related to stress. Weight loss as a result of an eating disorder such as anorexia nervosa is an important diagnosis to make because of the mortality rate of 5-15 percent. Psychiatric counseling is indicated in most, if not all cases.
If the primary cause is obesity, vigorous athletics, weight loss, or similar factors, treatment recommendations may include moderation in exercise and healthy weight control by using a healthy nutritional diet combined with appropriate lifestyle changes and psychological and/or emotional support.
A woman should keep a record of menstrual cycles to aid in early detection of recurrent amenorrhea.
MEDICATION
Therapeutic trial of hormone therapy using progesterone and/or estrogen. If bleeding occurs after progesterone is withdrawn, the reproductive system is functional.
Other drugs to treat underlying disorder may be prescribed.
Some drugs prescribed to women may cause secondary amenorrhea.
GENERAL PROGESTERONE THERAPY INFORMATION
Progesterone and estrogen are two main hormones made by the ovaries of menstruating women. Progesterone is also made in smaller amounts by the adrenal glands in both men and women and in males by the male testes. When a woman's monthly cycle is functioning correctly, estrogen is the dominant hormone during the first two weeks of the menstrual cycle. In response to ovulation, progesterone assumes dominance for the final two weeks of the month. A woman's menstrual cycle begins within 48 hours of the reduction in the production of progesterone caused by messages sent by the pituitary gland in the brain to the ovaries to stop progesterone production. When a woman's estrogen and progesterone hormones are out of balance, hormone related illnesses can emerge.
Menopause is normally defined as the end of menstrual cycles. The unpleasant symptoms of menopause that some women suffer such as hot flashes, vaginal dryness, and mood swings are peculiar to western industrialized societies. Menopause is often associated with the end of a woman's sexuality and the beginning of old age, arthritis, and osteoporosis.
Due to ovulatory cycles, progesterone levels typically decline before menopause starts and this is followed by a decline in estrogen. Progesterone production tends to fall to almost zero while estrogen declines to about 40 to 50 percent. This situation leads to an imbalance between estrogen and progesterone causing an increase in estrogen activity, which is now described as estrogen dominance.
Many women find that by supplementing their hormone production with natural progesterone they will reduce many or most of their menopausal symptoms. The presence of progesterone in the body sensitizes estrogen receptor sites thus enabling estrogen to work more efficiently. Progesterone is a precursor to other hormones in the body including estrogen, testosterone, and especially the corticosteroids.
Women are becoming better acquainted with the health benefits of natural progesterone. Natural Progesterone reduces the symptoms and discomfort of Menopause, PMS and Pre-menopause without the side effects often associated with synthetic hormone replacement therapy.
NATURAL PROGESTERONE BENEFITS
Benefits of natural progesterone include:
- Stimulated osteoblast bone building.
- Restored sex drive.
- Protects against fibrocystic breasts.
- Natural antidepressant.
- Facilitates thyroid hormone action.
- Normalized blood sugar, zinc and copper levels.
- Decreased breast cancer risk.
- Helps use fat for energy.
- Improved sleep patterns.
- Normalized blood clotting.
- Natural diuretic.
- Elimination of depression after childbirth.
POSSIBLE CAUSES FOR PROGESTERONE THERAPY
When estrogen is unopposed or unbalanced by progesterone many undesired effects occur. Stated differently, many of estrogen's undesirable side effects are effectively prevented by proper amounts of progesterone. The lack of progesterone causing estrogen dominance occurs mostly in industrialized countries and commonly occurs in the following situations:
- When women are on estrogen replacement therapy, which is now recognized as unsafe.
- During the development of pre-menopause caused by early follicle depletion resulting in the lack of ovulation and thus a lack of progesterone well before the onset of menopause.
- Exposure to xenoestrogens which is the cause of early follicle depletion. Xenoestrogens are foreign substances found outside the body in the air and food that have an estrogen enhancing effect on the body.
- Birth control pills with an excessive estrogen component.
- Women who have had a hysterectomy leading to dysfunction of the ovaries.
- Post-menopause, especially in overweight women.
POSSIBLE SYMPTOMS FOR PROGESTERONE THERAPY
Symptoms and medical problems that can be caused or made worse by estrogen dominance include allergies, fatigue, weight gain, memory loss, uterine cancer, hypoglycemia, uterine fibroids, breast tenderness, decreased sex drive, osteoporosis, PMS, gallbladder disease, miscarriage, accelerated of aging, depression, fibrocystic breasts, headaches, irritability, infertility, foggy thinking, and increased risk of strokes.
See Products & Supplements below for natural progesterone products.
ACTIVITY
No restrictions.
However, if amenorrhea has been cause by excessive physical exercise, this should be reduced to moderate levels. There may be restrictions depending upon the underlying cause and the therapy used to treat the condition.
DIET
Usually no special diet unless a woman is undernourished or obese. Follow a healthy diet plan.
If you are overweight or underweight, get medical advice about diets. Do not try to lose weight by crash-dieting or following fad-diets.
BENEFICIAL DIETARY SUPPLEMENTS
Progesterone has been shown to induce normal menstrual bleeding in women with secondary amenorrhea. See information above about progesterone therapy and natural progesterone products below under Supplements and Products.
Acetyl-L-Carnitine is an amino acid that can improve hormone levels in women with low initial levels. Carnitine is an amino acid produced endogenously in the kidneys and liver and is derived from meat and dairy products. Carnitine has been found to have health benefits associated primarily with heart health and plays an important role in the protection against heart disease. An additional health benefit of Carnitine is that it increases fat metabolism; therefore, it can help reduce the chances of becoming obese. Carnitine is a nutrient responsible for the transport of long chain fatty acids into the energy producing centers of the cells (known as mitochondria). In other words, Carnitine helps the body convert fatty acids into energy, which is used primarily for muscular activities throughout the body. Many athletes and body builders use Carnitine supplements because they believe it increases stamina and develops muscle mass. Some people have dietary deficiencies of Carnitine or cannot properly absorb this nutrient from foods that they eat. Carnitine deficiencies may be caused by genetic disorders, liver or kidney problems, high-fat diets, certain medications and low dietary levels of the amino acids Lysine and Methionine (substances needed to make Carnitine). Carnitine deficiencies may cause symptoms such as fatigue, chest pain, muscle pain, weakness, low blood pressure, and/or confusion. Most people do not need to supplement their diet with Carnitine; however, for therapeutic use, the standard dosage is 1-3 grams per day.
Calcium and Vitamin D prevent bone loss (osteoporosis). Calcium should be taken with Magnesium and Vitamin D for better absorption and support. Calcium is essential for the proper development of bones and teeth, and is involved in numerous enzymatic reactions that produce energy. It is necessary for healthy muscle functions such as muscle contraction and relaxation. Calcium also regulates heart rhythm and activates enzyme systems that induce blood clotting, and it has the ability to promote healing. It is one of the most essential major biochemical elements needed in human nutrition. Every organ in the body needs Calcium. It is stored in the blood and teeth, as well as in the nerves, muscles and tissues. Calcium promotes tone, power, strength, longevity, vitality, endurance, rapid wound healing, and helps regulate metabolism. It is easy for our bodies to become Calcium deficient because it is used in almost every function. When the diet is inadequate, Calcium is one of the first elements to go out of balance. Calcium raises the body's resistance to viruses, parasites, bacteria, and cancer. Calcium is beneficial to everyone, but research has shown that women may benefit more than others. Pregnant women who do not get enough in their diet can increase the bone mineral content of their fetus. PMS (premenstrual syndrome) is another condition that may be alleviated by the use of calcium supplements. Research has shown that women who took 1,200 mg per day reduced their symptoms by more than 50 percent. A 1999 study showed that women who take Calcium as a daily supplement reduce their risk of a stroke. Calcium is frequently prescribed with Estrogen at the beginning of menopause to treat or prevent osteoporosis.
Vitamin D, calciferol, is a fat-soluble vitamin. It is found in food, but also can be made in your body after exposure to ultraviolet rays from the sun. Vitamin D exists in several forms, each with a different activity. Some forms are relatively inactive in the body, and have limited ability to function as a vitamin. The liver and kidney help convert vitamin D to its active hormone form. The major biologic function of vitamin D is to maintain normal blood levels of calcium and phosphorus. Vitamin D aids in the absorption of calcium, helping to form and maintain strong bones. It promotes bone mineralization in concert with a number of other vitamins, minerals, and hormones. Without vitamin D, bones can become thin, brittle, soft, or misshapen. Vitamin D prevents rickets in children and osteomalacia in adults, which are skeletal diseases that result in defects that weaken bones. One cup of vitamin D fortified milk supplies about one-fourth of the estimated daily need for this vitamin for adults. Although milk is fortified with vitamin D, dairy products made from milk such as cheese, yogurt, and ice cream are generally not fortified with vitamin D. Only a few foods naturally contain significant amounts of vitamin D, including fatty fish and fish oils.
Blue Cohosh stimulates menstrual flow. Do not take during pregnancy. Today Blue Cohosh is used to regulate the menstrual flow and for treating suppressed menstruation. This herb eases muscle spasms and stimulates uterine contractions for childbirth and has been used in folk medicine to prevent miscarriage. Blue Cohosh has also been used to improve memory and calm nerves. This herb also reduces the inflammation of arthritis and rheumatism. Blue Cohosh is an excellent uterine tonic that may be used in any situation where there is weakness or loss of tone. European researchers have identified some antibiotic and immune-stimulating properties, it may have a potential in treating bladder and kidney infections. Blue Cohosh is also used in Homeopathy. The homeopathic remedy made from Blue Cohosh is called Caulophyllum and is recommended for menstrual cramps, PMS, dysmenorrhea and midwives use it for support during childbirth. Homeopaths may also prescribe Caulophyllum for gout, rheumatism, false labor pains and gonorrhea. Blue Cohosh comes in various forms and is an ingredient in many products. For making an infusion it is a 1:16 ratio of 15-30 ml every 2-4 hours. In using a tincture it is a 1:5 ration of 0.6-1.8 ml, 3 to 4 times per day. A Blue Cohosh extract is a 1:1 ratio in 60 percent alcohol, 0.3-0.9 ml, 3 times per day. For treating one of the conditions above, it is best to seek the advice of your midwife or health care provider before using Blue Cohosh for the treatment of your condition. Do not use during pregnancy unless under the guidance of your midwife.
Motherwort and Yarrow stimulates absent or light periods. Research has shown that Motherwort is able to calm palpitations and irregular heartbeat. It is used as a specific remedy for tachycardia caused by anxiety, and for all heart conditions that produce anxiety and tension. The glycosides in this herb have the short-term ability to lower blood pressure. Motherwort seeds are effective in stimulating a suppressed or delayed menstruation, and can ease dysmenorrhea, especially when there is anxiety or tension involved. It has also been used to ease false labor pains, and when taken as an infusion after childbirth, helps restore the uterus and reduce the risk of postpartum bleeding. Motherwort is also helpful in reducing the effects of menopause. The seeds are also said to brighten vision, and a decoction of seeds is used to relieve conjunctivitis or sore and tired eyes. The aerial part of the plant is used to treat eczema and sores. An infusion or diluted Motherwort tincture can be used as a douche for vaginal infections and discharges. To treat blood pressure, palpitations, irregular heartbeat, and anxiety, Motherwort should be taken for several months for best results. This herb comes in various forms so it is important to read and follow product label directions for treating your condition. Motherwort is a uterine stimulant and should be avoided during pregnancy, although it may be used during labor. There have been some incidents of dermatitis upon contact with the plant in susceptible individuals. It is suggested that those individuals with clotting disorders, high blood pressure, or heart disease refrain from using Motherwort.
Achillea millefolium, the scientific name for Yarrow, was derived from the Greek general Achilles. It was said that during the Trojan War Achilles used Yarrow to stop the bleeding of his soldier's wounds. Throughout time it has also been used as a treatment for respiratory infections, menstrual pain, and digestive upset. Though there have been no scientific studies to prove its effectiveness, Yarrow tea is commonly taken at the onset of a cold or flu to induce sweating and ward off infection. The crushed leaves and flower tops of this herb can be used in a poultice to stop nosebleeds and bleeding from minor wounds. To drink as a tea, steep 1 to 2 teaspoons of dried herb per cup of water. For other formulations, read product label directions. Yarrow has few if any side effects other than the occasional allergic reaction; however, safety in young children, pregnant or nursing women, or those with severe liver or kidney disease is not known.
Vitex Agnus-Castis (Chaste Tree Berry) reduces elevated prolactin levels that can cause amenorrhea. The fresh ripe Chaste Tree berries, when pounded to a pulp, have been used in the form of a tincture for the relief of paralysis, pains in the limbs, weakness, and breast pain, in addition to the menstrual regulation and treatment of hemorrhage. Clinical trials have shown that prolonged use of Chaste Tree Berries significantly reduces a range of PMS symptoms, from irritability and headaches to cramping and breast pain. The herb can lengthen the proliferative (first) phase of the menstrual cycle and also relieve water weight, headache and fatigue. Other trials have shown genuine effectiveness for women suffering from infertility and irregular periods. Chaste Tree Berry works well in reducing the symptoms such as hot flashes associated with peri-or post menopause. Some studies have shown the berries to be anti-androgenic and can therefore be used to help treat acne in men and women and reduce an overactive libido. Current research supports the ancient medicinal uses as the Vitex (Chaste Berry) causes the pituitary gland to produce a luteinizing hormone, which re-establishes the normal balance between estrogen and progesterone, thereby regulating a women's cycle. Chaste Tree Berry comes in various forms and is an ingredient in many products. The recommended dose is 1 capsule per day. For using a tincture, take 40 drops of the extract in the morning in a glass of water. With Chaste Tree Berry, no matter which formulation you use, it can take a awhile before the effects are noticeable, but usually a change is noticed by the third or fourth menstrual cycle after you begin taking it. For other formulations, read product label directions. Those on hormone replacement therapy should not take Chaste Tree Berry. If you are pregnant or nursing do not take this supplement. Safety in young children, or those with severe liver or kidney disease is not known.
See Products & Supplements below for these beneficial dietary supplements and products.
AMENORRHEA SUPPLEMENTS
Information and supplements for help with amenorrhea, the absence of menstrual periods. You need to determine the underlying cause of your amenorrhea before using any therapy for treatment.
Acetyl-L-Carnitine, Pharmaceutical Grade, NOW Foods, 500 mg, 100 Caps
Incorporating this stabilized form of NOW Foods L-Carnitine into our diet is an effective way to ensure that we are producing the energy we need to live full and active lives.Acetyl-L-Carnitine Powder, Vegetarian, NOW Foods, 635 mg, 3 oz.
Acetyl-L-Carnitine (ALC) is a stabilized form of the amino acid metabolite L-Carnitine and is utilized in the same manner in the body and it is the train that fats ride when it's time for them to go and be burned up for energy.Appetite Stimulant Formula Tincture, 100% Organic, 2 fl. oz.
This herbal appetite stimulant has been designed by a Master Herbalist to stimulate the appetite. It combines herbs well known, and recommended by the German Commission E, for improving the appetite and eliminating symptoms of appetite loss.Appetite Suppressor RX, 60 Tabs
Nature's Rx Appetite Suppressor Rx is the comprehensive appetite suppressant diet supplement which is all natural, stimulant free containing no ephedra, caffeine or other dangerous stimulants.Beauty Mate Herbal Tea, 20 Tea Bags
Beauty Mate herbal tea is especially designed for Women. It is very effective in regulating cycles and improving blood circulation, maintaining a good skin texture and a clear completion.Blue Cohosh (Caulophyllum Thalictroides) Powder, 4 oz. Bulk
Blue Cohosh is used to regulate the menstrual flow and for treating suppressed menstruation.Blue Cohosh (Caulophyllum Thalictroides) Tincture, 100% Organic, 2 fl. oz.
Blue Cohosh is used to regulate the menstrual flow and for treating suppressed menstruation.Bone Calcium, NOW Foods, 120 Tabs
Bone Calcium is a unique nutritional supplement formulated with calcium-rich, high collagen Microcrystalline Hydroxypatite (MCH). MCH is the actual form of calcium found naturally in bone tissue. It provides both the organic and inorganic constituents found in the skeletal structure. It also contains Vitamin D and trace minerals to help support calcium utilization.Calcium Carbonate Powder, NOW Foods, 12 oz.
NOW Foods Calcium Carbonate is a basic calcium supplement that contains one of the highest concentrations of elemental calcium, about 40 percent, making it an optimal formulation for supporting healthy bones and teeth.Calcium Citrate Chewables, TwinLab, 1000 mg, 60 Wafers
Calcium Citrate in an ionized, soluble and chelated form of calcium preferred by many health and nutritional experts.Calcium Citrate Malate Complex, Nature's Way, 500 mg, 250 Caps
Take Nature's Way Citrate Malate complex for superior calcium uptake and for proper bone development and muscle function.Calcium Complex Bone Formula, Nature's Way, 100 Caps
Calcium, Magnesium, and other minerals help maintain normal structure and development of bones. Studies have shown that calcium supplementation may help to maintain normal bone density among women as they age.Calcium Gluconate Powder, 100% Pure, NOW Foods, 7 oz.
Calcium - naturally occurring in some foods - is a mineral that is necessary for bone maintenance and formation and many other normal functions of the body and calcium can also aid in the removal of other minerals from the body.Calcium Ionic Mineral Supplement, Fully Absorbable, 700 +/- ppm, 16 fl. oz.
WaterOz Ionic Calcium is a pure liquid Calcium supplement. Calcium is one of the most essential of the major biochemical elements needed in human nutrition.Calcium Lactate, TwinLab, 100 mg, 100 Caps
TwinLab Calcium Lactate Caps are easier to swallow and assimilate and well tolerated by most highly allergic individuals.Calcium, Magnesium & Vitamin D, 100% Natural, Nature's Way, 166 mg/83 mg/66 IU, 250 Caps
Calcium, Mag & D (Calcium, Magnesium & Vitamin D) is a 100% natural blend of three important nutrients that includes an advanced chelate complex which enhances absorption.Cal-Mag Stress Formula, Calcium & Magnesium Supplement, NOW Foods, 100 Tabs
NOW Foods Cal-Mag Stress Formula, Calcium Magnesium Supplement provides a full spectrum of B-vitamins and Vitamin C.Chaste Tree Berry Powder (Vitex Agnus Castus), 4 oz. Bulk
Chaste Tree Berry (Vitex agnus castus) is ancient in European tradition for hemorrhage following childbirth and menstrual regulation, discussed at length by Hippocrates, Dioscorides and Theophrastus. A double-blind study, confirming other studies, showed Vitex to be more effective than vitamin B-6 in controlling PMS symptoms.Chaste Tree Berry Supplement Tincture, 2 fl. oz.
Chaste Tree Berry Supplement helps support the female reproductive system. Chaste Tree also helps regulate and balance female hormones and increases progesterone levels.Chaste Tree Berry / Vitex Tincture, Fertility and Herbal PMS Remedy, 2 fl. oz.
Chaste Tree Berry is an Herbal PMS remedy and a natural fertility herb. Trials have shown genuine effectiveness of Chaste Tree Berries for women suffering from infertility and irregular periods.Coral Calcium Complex Liquid, 100% Pure Okinawan, Dynamic Health, 32 fl. oz.
Coral Calcium Coral liquid provides valuable Marine Nutrients.Coral Calcium Liquid With ConcenTrace, Orange Vanilla, Trace Minerals, 1000 mg, 32 fl. oz.
Coral Calcium with ConcenTrace contains a highly absorbable form of every mineral needed by the body.Coral Calcium (Okinawa) Powder, NOW Foods, 6 oz.
Okinawa Coral Calcium Plus with Magnesium, Vitamin D and 70 other trace minerals provides essential minerals, restores body alkalinity, supports the immune system, and is bio-available for better absorption.Damiana Leaves Powder (Turnera Diffusa), 4 oz. Bulk
Damiana Leaves (Turnera diffusa) is held in high repute by Mexican herbalists, particularly as an aphrodisiac, prescribed as a thick decoction before bedtime.DIM-Plus Estrogen Metabolism / Diindolylmethant Protectamins Cruciferous, Nature's Way, 120 Caps
DIM-Plus Estrogen Metabolism Formula promotes healthy estrogen metabolism, Relieves PMS symptoms, Promotes fat loss, supports breast, cervical, uterine and prostate health. Scientific research shows diindolylmethane increases the level of "good" estrogens (2-hydroxyestrogen) while reducing the level of "bad" estrogens (16-hydroxyestrogen).Dong Quai Root Powder (Angelica Sinensis), 4 oz. Bulk
Dong Quai root (Angelica sinensis), referred to as the female ginseng, is rich in vitamins and minerals and is one of the most widely used herbs in traditional Chinese medicine. It is effective for female disorders such as menstrual disturbances, PMS and hot flashes due to its anti-inflammatory, analgesic, antiseptic, bactericidal and vasodilative effects. The herb is also used to regulate menstrual cycles, relieve menstrual cramps and alleviate symptoms related to PMS.EFA-Gold Super Lignan, Herbal Estrogen Supplement, Nature's Way, 60 VCaps
EFAGold Super Lignan is an ideal herbal estrogen supplement for supporting breast health during the menopausal phases of life helping alleviate breast tenderness and pain associated with the menstrual cycle.EstroPause, Menopause Support, Irwin Naturals, 80 Gelcaps
Irwin Naturals EstroPause has been carefully formulated to support hot flash control, memory & mood, estrogen production, bone density, eye, heart, colon and vaginal moisture.False Unicorn Tincture, 100% Organic, 2 fl. oz.
Many herbalists recommend False Unicorn for reducing menopausal symptoms, and treating ovarian cysts. It has also been used to normalize hormone levels following oral contraceptive use.Female Energy & Power Formula Tincture, 2 fl. oz.
This herbal energy formula combats fatigue naturally and increases vitality.Femaprin Vitex Extract, Pharmaceutical Grade, Nature's Way, 425 mg, 60 Caps
Femaprin's Vitex extract is unique formula combines clinically proven standardized Vitex Chaste Tree Berry extract with Vitamin B-6 to help alleviate the bloating, breast tenderness and mood changes associated with premenstrual syndrome.Feverfew Extract (Natural Headache Remedy), Standardized, Nature's Way, 325 mg, 60 Caps
Nature's Way Feverfew extract, a natural headache remedy, offers the benefits of a standardized extract and full spectrum of the whole herb.Feverfew Leaves, Nature's Way, 380 mg, 180 Caps
Feverfew leaves helps maintain normal blood vessel tone and Feverfew leaves are best used for long-term treatment and prevention of migraine headaches.Female Balance, NOW Foods, 90 Caps
Scientifically engineered to support the normal hormone function of today's active female with Wild Yam, Borage Oil, Dong Quai and folic acid, this perfectly balanced blend of potent herbal extracts and essential fatty acids (omega-3 and 6) may encourage normal menstruation, reduce the severity of cramps and support a healthy positive mood.Female Estrogen with Progesterone Tincture, 100% Organic, 2 fl. oz.
Female Estrogen With Progesterone formula is used mainly to promote hormonal balance. It does not contain hormones, however.Get A Grip Herb Tea For PMS / Menopause No. 4, Republic of Tea, 36 Tea Bags
Women are complex creatures, often ruled by a delicate balance of hormones. But when those hormones are out of balance, or monthly blues cramp your style, it's reassuring to know you can get a grip with a simple cup of this herbal tea.Just An Ounce, Liquid Calcium & Magnesium, Almond Flavor, 16 fl. oz.
Just An Ounce, Calcium and Magnesium Liquid can help with the development of strong bones and teeth, also prevents muscle cramping, risk of colon cancer, maintain regular heart beat, protects against osteoporosis and helps relax the central nervous system.L-Carnitine, Liquid Double Strength, NOW Foods, 16 fl. oz.
NOW L-Carnitine Liquid provides all of the extensive benefits of Carnitine in a highly absorbable liquid form. L-Carnitine Liquid is a non-essential amino acid that helps to maintain overall good health by facilitating the transfer of fatty acid groups into NOW L-Carnitine 2X Liquid provides double (1 gram) the potency of some competing brands per serving size.L-Carnitine, Stable Tartrate Form, NOW Foods, 250 mg, 30 Caps
Pure L-Carnitine is an amino acid that normally attracts water which can cause it to deteriorate rapidly. They use a tartrate form to help ensure that NOW L-Carnitine maintains stability and full potency.L-Carnitine, Stable Tartrate Form, NOW Foods, 500 mg, 30 Caps
L-Carnitine is a non-essential amino acid that helps to maintain overall good health by facilitating the transfer of fatty acid groups into the mitochondrial membrane for cellular energy production.L-Carnitine, Stable Tartrate Form, NOW Foods, 500 mg, 60 Caps
L-Carnitine is a non-essential amino acid that helps to maintain overall good health by facilitating the transfer of fatty acid groups into the mitochondrial membrane for cellular energy production.Liquid Calcium, Magnesium & Zinc (Liquimins), Natural Pina Colada Flavor, Trace Minerals, 32 fl. oz..
Liquid Calcium / Magnesium / Zinc is a perfectly balanced daily liquid supplement of calcium, magnesium, zinc and vitamin D synergistically formulated to support bone, muscle and connective tissue health.Liquid L-Carnitine Plus Pantothenic Acid, Dynamic Health, 16 fl. oz.
Dynamic Health's liquid l-carnitine can help boost energy, build new muscle and improve mental performance.Live Young HGH Homeopathic, 90 Chewable Tabs
This Homeopathic Oral HGH Formula provides the same benefits found in synthetic injectable HGH without the costs and dangerous side effects of synthetic HGH.Menopause Support, NOW Foods, 90 Caps
Menopause Support from NOW contains recommended potencies of key ingredients that have been shown to support normal hormonal levels during menopause.Menopause Support, TheraVedas Anita, 60 Caps
TheraVedas Anita Menopause Support formula was developed to support a woman's body as her active reproductive period declines and she enters a peri-menopausal and menopausal phase.Moon Cycle Tea With Dong Quai, Woman's tea, Certified Organic, 16 Tea Bags
Yogi Tea Woman's Moon Cycle Tea with Dong Quai is an organic way to regulate mood swings, cramps and other minor symptoms of premenstrual discomfort.Motherwort Powder (Lion's Tail - Leonurus Cardiaca), 4 oz. Bulk
Motherwort shows its relevance to menstrual and uterine conditions - cardiaca indicates its use in heart and circulation treatments.Motherwort Tincture, 100% Organic, 2 fl. oz.
Research has shown that Motherwort is able to calm palpitations and irregular heartbeat.Natural Calm Plus Calcium, Anti-Stress Drink, Peter Gillham's Natural Vitality, 8 oz.
A superior formulation for best calcium assimilation. Peter Gillham's Natural Calm Plus Calcium is formulated with 3 parts magnesium to 2 parts calcium, which will prevent a surplus of calcium robbing the body's vital magnesium supply and avoid the symptoms associated with depleted levels of magnesium.Natural Hormone Replacement For Women Over 45, By Jonathan Wright, M.D. & J. Morgenthaler
Finally, an alternative to conventional hormone replacement therapy - compelling evidence that natural hormone replacement (NHR) provides all the benefits of conventional HRT but with drastically reduced risks of unwanted side effects and cancer.Natural Progesterone Cream: A Safe Alternative to Conventional Hormone Replacement Therapy, By C. Norman Shealy, M.D., Ph.D.
In this Keat's Good Health Guide, Dr. Norman Shealy answers all your questions about natural progesterone cream, a viable and safe alternative to synthetic hormone replacement therapy.Natural Progesterone Cream Liposomal Cream With Lavender, NOW Foods, 3 oz.
Calming lavender Progesterone Liposomal Skin Cream with 20 mg of natural Progesterone per pump from Wild Yam & balancing herbs. No artificial colors, fragrances or parabens and no animal testing.Natural Progesterone Cream Liposomal Lotion, NOW Foods, 3 oz.
Natural Progesterone Cream is effective for women experiencing the symptoms of mid-life, before, during and after menopause.Noni Menopause Formula (Morinda Citrifolia), Organic, Kosher & Vegetarian, Enriched With Pomegranate Juice, Dynamic Health, 32 fl. oz.
The fruit of the Morinda Citrifolia (NONI) plant has been treasured for thousands of years by the native people inhabiting the exotic island of Tahiti.Pregnenolone Cream, Life-Flo, 2 oz.
Life Flo's Pregnenolone Cream contains natural pregnenolone, tocotrienols, primrose oil, lecithin, MSM and grape seed extract.ProgestaCare Life-Flo, Natural Progesterone Cream, Women's Formula, 100% Natural, 4 oz.
ProgestaCare Natural Progesterone Cream helps women reduce the severity of PMS symptoms lessen the effects of menopause and counter-balance the effects of estrogen dominance, Infertility, Migraines, Fibrocystic Breast, Skin Care, and Acne.ProgestaCare, Natural Progesterone Cream, Men's Formula, 100% Natural, 3 oz.
Medical researchers are just now discovering the many health benefits that natural progesterone cream can offer men.ProgestaCare Plus, Life-Flo With Phytoestrogens, 4 oz.
ProgestaCare Plus combines ProgestaCare's bio-identical progesterone with the highest quality all natural phytoestrogens.Progesta, Natural Progesterone Cream, 2 oz.
Progesta is a unique natural progesterone supplement that provides incredible feminine support for overall mental health, normal feminine cycles and more.Raspberry Leaf Tea, Female Support, Yogi Tea, 16 Tea Bags
Yogi Tea Organic Woman's Raspberry Leaf is a gentle and organic way to support the special needs of a woman's reproductive system.Relora, NOW Foods, 300 mg, 60 Caps
Relora is used to normalize hormone levels associated with stress-induced obesity and poor eating and drinking behaviors. Preliminary findings suggest that Relora can decrease the cravings for high fat and high sugar foods in stressed individuals.Tansy Herb Tincture, 100% Organic, 2 fl. oz.
Tansy Herb Tincture is used to expel worms, especially round and thread worms.Vitamin D, Dry, Nature's Way, 100% Natural, 400 IU, 100 Caps
Vitamin D helps the body to regulate the transport of calcium from the digestive system through the bloodstream to bone. It also assists in the retention of calcium and phosphorus.Vitamin D, NOW Foods, 1000 IU, 180 Softgels
As an essential part of the human diet, Vitamin D plays an active role in many facets of metabolism and development. Most importantly, this fat-soluble vitamin assists the body in the absorption of calcium and phosphate, thus promoting stronger bones and teeth.Vitamin D, NOW Foods, 2000 IU, 120 Softgels
NOW Vitamin D softgels supply this key vitamin in a highly-absorbable liquid softgel form. Vitamin D is normally obtained from the diet or produced by the skin from the ultraviolet energy of the sun. However, it is not abundant in food. As more people avoid sun exposure, Vitamin D supplementation becomes even more necessary to ensure that your body receives an adequate supply.Vitex Fruit (Chaste tree), 400 mg, 100 Caps
Vitex is a woman's dietary supplement, traditionally used for menstrual difficulties. Vitex has been heavily researched in Europe. It is widely used to promote overall health and balance in a woman's life.What Your Doctor May Not Tell You About Breast Cancer, By Dr. John R. Lee
Dr. Lee points the finger at the most likely sources responsible for the increase in breast cancer. What Your Doctor May Not Tell You About Breast Cancer includes life saving breast cancer information.What Your Doctor May Not Tell You About Menopause, The Breakthrough Book On Natural Hormone Balance, By John R. Lee, M.D. & Virginia Hopkins
Dr. Lee brings you lifesaving facts that even your doctor may not know about Premarin, Provera, and other HRT drugs; gives you an easy-to-follow non-prescription "Hormone Balance" program; and tells you how to stay energized, strong, sexually vigorous, and free from "female problems" before menopause, during the menopausal years, and beyond.What Your Doctor May Not Tell You About Pre-Menopause, Balance Your Hormones & Your Life From 30 to 50, By John R. Lee, M.D. & Jesse Hanley, M.D.
Presents a safe, revolutionary, non-prescription program to balance hormones, restore gynecological health, energy and sex drive and slow the aging process before menopause and even after.Wild Yam Root, Certified, 425 mg, 180 Caps
Wild Yam was historically offered as colic root and used in herbal remedies for gastrointestinal irritations.Woman's Raspberry Leaf, Female Support, 16 Tea Bags
Our Organic Woman's Raspberry Leaf is a gentle and organic way to support the special needs of a woman's reproductive system.Yarrow Flowers, 325 mg, 100 Caps
Yarrow (Achillea millefolium) may be helpful for Nosebleeds, fevers, colds, sore throat, indigestion, heartburn, inflammation, menstruation, dysmenorrhea, high blood pressure, muscle spasms, urinary tract infections, and minor injuries.Herbal Remedies: Amenorrhea / Absence of Menstrual Period Information
Herbal Remedies: Amenorrhea / Absence of Menstrual Period Supplements & Products
PRODUCTS FOR CYCLE CHARTING, OVULATION MONITORING, PREGNANCY TESTS
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
You or a family member has symptoms of amenorrhea. If you are a woman and have missed more than one period so that the cause, and appropriate treatment, can be determined.
Periods do not begin in 6 months after treatment.
New, unexplained symptoms develop. Hormones or drugs used in treatment may produce side effects.
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Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
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Prescription for Herbal Healing: The A-To-Z Reference To Common Disorders
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