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DESCRIPTION
Primary amenorrhea is the complete absence of menstruation in a young woman who is at least 16 years old, or at age 14 with a lack of normal growth or absence of normal sexual development. It is a rare disorder as over 95 percent of girls have their first menstrual period by age 15.
FREQUENT SIGNS & SYMPTOMS
No menstrual flow. Lack of menstrual periods after puberty. Most girls begin menstruating by age 14, average age is 12 years and 8 months.
CAUSES
Usually unknown. Primary amenorrhea in the United States occurs in less than 0.1 percent of girls. Possible causes include:
- Delayed puberty.
- Congenital abnormalities, such as the absence or abnormal formation of female organs (vagina, uterus, ovaries). Vaginal septum, cervical stenosis, imperforate hymen.
- Intact hymen (imperforate hymen), the membrane covering the vaginal opening that has no opening to allow passage of menstrual flow.
- Gonadal dysgenesis.
- Hypoglycemia.
- Hypothyroidism and hyperthyroidism.
- Cystic fibrosis.
- Cushing's disease.
- Polycystic ovarian disease.
- Chronic (long term) illness.
- Chromosome disorders and abnormalities. Turner's syndrome (XO) or Sawyer's syndrome (XY).
- Systemic disease or infection.
- Hypogonadotropic hypogonadism.
- Hyperprolactinemia.
- Testicular feminization.
- True hermaphroditism.
- Adrenogenital syndrome.
- Congenital heart disease (cyanotic).
- Congenital adrenal hyperplasia.
- Craniopharyngioma. Pituitary tumors, ovarian tumors, adrenal tumors.
- Prader-Willi syndrome.
- Malnutrition.
- Drastic weight reduction (from poverty, fad dieting, anorexia nervosa, bulimia, strenuous exercise or other causes).
- Extreme obesity.
- Pregnancy.
RISK INCREASES WITH
Stress.
Use of drugs, including oral contraceptives, anticancer drugs, barbiturates, narcotics, cortisone drugs, chlordiazepoxide and reserpine.
Excessive exercise.
Family tendency to start menstruation late.
Excessive dieting or weight loss.
Psychological eating disorders such as Bulimia or Anorexia Nervosa.
PREVENTIVE MEASURES
Don't use drugs unless prescribed by a health care provider.
Don't use mood-altering, mind-altering, stimulant, or sedative drugs.
Reduce athletic activities if they are too strenuous. Maintain a healthy muscle-fat ratio in the female body.
Obtain medical and/or psychological treatment for any underlying disorder.
Maintain proper nutrition and body weight. A growing body during adolescence needs plenty of healthy nutritious food to grow.
EXPECTED OUTCOME
The absence of menstruation is not a health risk in itself, but the cause should be identified. If an ovarian cyst or tumor is the cause, it requires removal.
Amenorrhea is usually curable with hormone treatment or removal of the underlying cause. Treatment may be delayed to age 18 unless the cause can be identified and treated safely.
Causes which sometimes cannot be corrected include chromosome disorders and abnormalities of the reproductive system.
Overall outlook is good, depending on the cause of the amenorrhea. If the amenorrhea is caused by one of the following conditions, there is a good possibility of correcting the amenorrhea through medication, lifestyle change, or surgery.
- Normal delay of onset (up to age 14 or 15).
- Drastic weight reduction (resulting from poverty or fad dieting).
- Hypoglycemia.
- Extreme obesity.
- Hypogonadotropic hypogonadism.
- Chronic illness.
- Malnutrition.
- Congenital heart disease (cyanotic).
- Hyperthyroidism.
- Imperforate hymen.
- Adrenogenital syndrome.
If the amenorrhea is caused by one of the following conditions, it is unlikely that the amenorrhea can be corrected by any method.
- Congenital abnormalities of the genital system.
- Gonadal dysgenesis.
- Turner's syndrome (XO).
- Testicular feminization syndrome.
- True hermaphroditism.
- Cystic fibrosis.
- Craniopharyngioma.
- Prader-Willi syndrome.
If the amenorrhea cannot be corrected, it is sometimes possible to create a pseudo-menstruation with medications to help the young woman feel more like her friends or family.
POSSIBLE COMPLICATIONS
Psychological distress about sexual development. Emotional distress or crisis about being different from friends or family can occur.
Inability to conceive.
Rare endocrinological condition may require surgical treatment in addition to hormone replacement.
TREATMENT
GENERAL MEASURES
DIAGNOSIS
Physical examination and medical history is taken and assessed.
Diagnostic tests may include a thorough physical examination, and a medical and personal history, laboratory studies of blood samples to check for hormone levels, plus thyroid and adrenal function studies.
- Urine pregnancy test.
- Progesterone withdrawal.
- Chromosome analysis.
- Serum chemistry (serum gonadotropin).
- LH
- FSH
- Prolactin
- TSH
- T3 and T4
- Urine chemistry, 17-ketosteroids.
- Head CT.
- Head MRI scan.
- Laparoscopy.
- Ultrasound, pelvic region.
TREATMENT
Treatment depends on the cause of the missing period. Primary amenorrhea caused by birth defects may require medications (hormone therapy), surgery, or both.
Treatment usually involves hormone replacement therapy. Treatment for amenorrhea not related to hormone deficiency depends on the cause.
If the amenorrhea is caused by a tumor of the brain (pituitary tumor), the tumor is usually treated with a drug called bromocriptine. Surgery to remove the tumor may also be necessary. Radiation therapy is usually only performed when other treatments have not worked.
Surgery (minor) to create an opening in the hymen, if necessary.
Surgery to correct abnormalities of the reproductive system, if possible.
MEDICATION
You may be prescribed progesterone (hormone) treatment to induce bleeding. If bleeding begins when progesterone is withdrawn, the reproductive system is functioning. This also indicates that pituitary disease is unlikely. If progesterone withdrawal does not induce bleeding, gonad stimulants such as clomiphene or gonadotrophins may be used for the same purpose.
ACTIVITY
No restrictions. Exercise regularly, but not to excess.
Sleep at least 8 hours every night.
DIET
Eat three well-balanced meals a day.
If you are overweight or underweight, get medical advice about diets. Do not try to lose weight by crash-dieting. Avoid fad diets since they can be very nutritionally unhealthy.
MoonDragon's Nutrition Information & Index
BENEFICIAL DIETARY SUPPLEMENTS FOR AMENORRHEA
Progesterone has been shown to induce normal menstrual bleeding in women with amenorrhea.
Herbal Remedies: Natural Progesterone Cream Liposomal Cream With Lavender, NOW Foods, 3 oz.
Herbal Remedies: Natural Progesterone Cream Liposomal Lotion, NOW Foods, 3 oz.
Herbal Remedies: Noni Menopause Formula (Morinda Citrifolia), Organic, Kosher & Vegetarian, Enriched With Pomegranate Juice, Dynamic Health, 32 fl. oz.
Herbal Remedies: Pregnenolone Cream, Life-Flo, 2 oz.
Herbal Remedies: ProgestaCare Life-Flo, Natural Progesterone Cream, Women's Formula, 100% Natural, 4 oz.
Herbal Remedies: ProgestaCare Plus, Life-Flo With Phytoestrogens, 4 oz.
Herbal Remedies: Progesta, Natural Progesterone Cream, 2 oz.
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.
Herbal Remedies: Acetyl-L-Carnitine, Pharmaceutical Grade, NOW Foods, 500 mg, 100 Caps
Herbal Remedies: Acetyl-L-Carnitine Powder, Vegetarian, NOW Foods, 635 mg, 3 oz.
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.
Herbal Remedies: Bone Calcium, NOW Foods, 120 Tabs
Herbal Remedies: Calcium Carbonate Powder, NOW Foods, 12 oz.
Herbal Remedies: Calcium Citrate Chewables, TwinLab, 1000 mg, 60 Wafers
Herbal Remedies: Calcium Citrate Malate Complex, Nature's Way, 500 mg, 250 Caps
Herbal Remedies: Calcium Complex Bone Formula, Nature's Way, 100 Caps
Herbal Remedies: Calcium Gluconate Powder, 100% Pure, NOW Foods, 7 oz.
Herbal Remedies: Calcium Ionic Mineral Supplement, Fully Absorbable, 700 +/- ppm, 16 fl. oz.
Herbal Remedies: Calcium Lactate, TwinLab, 100 mg, 100 Caps
Herbal Remedies: Coral Calcium Complex Liquid, 100% Pure Okinawan, Dynamic Health, 32 fl. oz.
Herbal Remedies: Coral Calcium Liquid With ConcenTrace, Orange Vanilla, Trace Minerals, 1000 mg, 32 fl. oz.
Herbal Remedies: Coral Calcium (Okinawa) Powder, NOW Foods, 6 oz.
Herbal Remedies: Cal-Mag Stress Formula, Calcium & Magnesium Supplement, NOW Foods, 100 Tabs
Herbal Remedies: Calcium, Magnesium & Vitamin D, 100% Natural, Nature's Way, 166 mg/83 mg/66 IU, 250 Caps
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.
Herbal Remedies: Vitamin D, Dry, Nature's Way, 100% Natural, 400 IU, 100 Caps
Herbal Remedies: Vitamin D, NOW Foods, 1000 IU, 180 Softgels
Herbal Remedies: Vitamin D, NOW Foods, 2000 IU, 120 Softgels
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.
Herbal Remedies: Blue Cohosh Powder (Caulophyllum Thalictroides), 4 oz. Bulk
Herbal Remedies: Blue Cohosh (Caulophyllum Thalictroides) Tincture, 100% Organic, 2 fl. oz.
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.
Herbal Remedies: Motherwort Tincture, 100% Organic, 2 fl. oz.
Herbal Remedies: Motherwort Powder (Lion's Tail - Leonurus Cardiaca), 4 oz. Bulk
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.
Herbal Remedies: Yarrow Flowers, 325 mg, 100 Caps
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.
Herbal Remedies: Chaste Tree Berry Powder (Vitex Agnus Castus), 4 oz. Bulk
Herbal Remedies: Chaste Tree Berry Supplement Tincture, 2 fl. oz.
Herbal Remedies: Chaste Tree Berry / Vitex Tincture, Fertility and Herbal PMS Remedy, 2 fl. oz.
FOR MORE INFORMATION ABOUT AMENORRHEA
AMENORRHEA SUPPLEMENTAL PRODUCTS
Products and supplements for the absence of the menstrual period.
Appetite Stimulant Formula Tincture, 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.Blue Cohosh Tincture, 100% Organic, 2 fl. oz.
Blue Cohosh supplements are used to regulate the menstrual flow and for treating suppressed menstruation.Calcium Complex Bone Formula, Nature's Way, 100 Caps
Nature's Way Calcium Complex Bone Formula provides the key minerals and trace elements necessary for the dynamic process that maintains bone mass.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.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.Female Estrogen With Progesterone Tincture, 2 fl. oz.
Female Estrogen With Progesterone formula is used mainly to promote hormonal balance. It does not contain hormones, however.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.Motherwort Tincture, 100% Organic, 2 fl. oz.
Research has shown that Motherwort is able to calm palpitations and irregular heartbeat.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.Raspberry Leaf, Woman's 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 normalizes 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.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.Tansy Herb Tincture, 2 fl. oz.
Tansy Herb Tincture is used to expel worms, especially round and thread worms.Vitex Fruit (Chaste Tree), 400 mg, 100 Caps
Vitex Fruit (Vitex agnus-castus) or Chaste tree is a woman's dietary supplement, traditionally used for menstrual difficulties.Yarrow Flowers Herb, 325 mg, 100 Caps
Yarrow Flower Herb 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 Supplements & Products
POSSIBLE LIFESTYLE CHANGES FOR AMENORRHEA
Get adequate amount of exercise and avoid stress.
Be sure to get plenty of sleep.
Smoking and substance abuse have been linked to amenorrhea, so avoid tobacco products and other stimulants.
NOTIFY YOUR HEALTH CARE PROVIDER IF...
You are 16 years old and have never had a period.
Periods do not begin in 6 months, despite treatment.
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Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
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Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 4th Edition
Prescription for Herbal Healing: The A-To-Z Reference To Common Disorders
-- by Phyllis A. Balch
The Complete Guide to Natural Healing
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