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.
Amenorrhoea (Greek: a - no; + men - month; + rhoia - flow) is the absence of periods. This is a normal (physiological) occurrence in girls before puberty (menarche), during pregnancy and breastfeeding (lactation) and following menopause. But failure to menstruate after puberty is called Amenorrhoea. It is generally regarded as abnormal by the age of 14 years in girls without other signs of secondary sexual development, or by the age of 16 in girls with normal secondary sexual characteristics. Absence of menstruation for six consecutive months before menopause in a woman who has previously had regular periods is also termed as amenorrhoea. The first condition is called vilambit artava (delayed menstruation) and second condition is called Artavavrodh (suspension of menstruation)
Following are the organs that are responsible for regular menstruation:
Uterus, ovaries, fallopian tubes and vagina: It is very important to have normal physiology and anatomy of these organs. Blood: It is important to have regular blood level. Nervous system and endocrine system: Nervous system coordinates all the gynaecological organs with endocrine system with the mind of the woman. Thus, it is very important to have healthy nervous system.
Amenorrhoea is of two types
Primary amenorrhoea: If a girl has not had her first period by the time she is 16, this is known as primary amenorrhoea. Secondary amenorrhoea: This is when a woman, who has menstruated normally in the past, stops having periods, temporarily or permanently. While many women skip an occasional period for different reasons, amenorrhoea is diagnosed if the woman has missed three or more periods in a row.
Types of Amenorrhoea according to doshas
Vataj: It is primarily due to aggravation of vata dosha. Kaphaj: It is primarily due to aggravation of kapha dosha. Vata-kaphaj: There is involvement of both the doshas. But vata is the prime dosha.
Nidan (Causes of Amenorrhoea) According to the Ayurveda, perspective, imbalance of tridoshas and three mental properties lead to Amenorrhoea. Aggravated vata and kapha dosha and low pitta dosha are responsible for Amenorrhoea. Specifically, imbalanced or high apana vata is responsible for amenorrhoea. Located in the pelvic region, it controls the flow of menstruation.
Mental properties like high rajsic properties high tamsic properties and low sattvik properties of mind are responsible for Amenorrhoea.
The causes for Primary Amenorrhoea
Eating disorders such as anorexia nervosa and bulimia: Eating disorders cause nutritional deficiency and deterioration of the dhatus (body tissues). According to Ayurveda, kshya or deterioration increases vata dosha. This aggravated vata dosha leads to Amenorrhoea. Intense physical athletic training before puberty: Intense physical athletic training also causes deterioration of dhatus (body tissues). Kshya or deterioration increases vata dosha. This aggravated vata dosha leads to Amenorrhoea. Extreme obesity: Extreme obesity causes aggravation of kapha dosha. Kapha dosha causes blockage of srotas and causes Amenorrhoea. Drugs such as certain antidepressants may cause primary Amenorrhoea. Chronic illnesses like thyroid problems, Anaemia, Chlorosis, Tuberculosis, diabetes cause aggravation of vata and kapha dosha. These diseases block the artavavahi channels, which leads to Amenorrhea. Turner's Syndrome: This is when a woman is born with only one X chromosome (there should be two). Turner's Syndrome results in the woman having no ovaries, therefore menstruation cannot take place.
Congenital obstructive defects in lower genital tract e.g. non-canalisation of cervix, vagina or an imperforate hymen
Causes for Secondary Amenorrhoea
Stress: Negative mental feelings like stress, tension, anger, or sorrow affect menstruation. Very often, women do not have periods while changing jobs or schools, travelling, or when under emotional duress. Stress aggravates the prana vata. Prana vata is subdosha of vata dosha. It stays in the brain and controls our nervous system. Aggravated prana vata causes imbalance of the next subdosha that is apana vata. Thus, stress and tension create an imbalance of apana vata, which leads to Amenorrhoea. Contraceptives: Some women on the oral contraceptive pill ("The Pill" and "The Mini-Pill"), and many women on Depo Provera injections experience no periods. Regular and prolonged use of these contraceptives can cause aggravation of vata, which leads to Amenorrhoea. Rapid weight loss often caused by an eating disorder: Eating disorders cause nutritional deficiency and deterioration of dhatus (body tissues). According to Ayurveda, kshya or deterioration increases vata dosha. This aggravated vata dosha leads to Amenorrhoea Excessive exercise: Exercising beyond one's capacity can deteriorate the dhatus (body tissues). Kshya or deterioration increases vata dosha. This aggravated vata dosha leads to Amenorrhoea. Increase of cold temperament in the body at the commencement of menstruation or during menstruation also causes aggravation of vata dosha, which leads to Amenorrhoea. Thus it is very important to keep the body warm at commencement of menstruation or during menstruation. Excessive lethargy and sedentary lifestyle aggravates the kapha dosha, which blocks menstrual channels, leading to Amenorrhoea. Marijuana use and chronic illness can also cause Amenorrhoea. Polycystic ovaries or ovarian tumour can cause Amenorrhoea. Medical therapies: Occasionally, periods can stop after pelvic surgery or chemotherapy. Prescription medicines such as Haloperidol can also cause Amenorrhoea. Hormonal disorders: Rarely, benign (non-cancerous) tumours can occur in the pituitary gland. This leads to an excess of the hormone Prolactin that can stop periods, and cause a milky discharge from the nipples. Disorders of other glands such as the thyroid, adrenal and the ovaries can also cause periods to stop but these are rare.
Common causes for both types of Amenorrhoea
Diet Eating excessively cold, light, dry, or airy foods increase vata dosha in the body. Eating gas forming vegetables and fruits like cabbage, broccoli, cauliflower, beans, lettuce, mushrooms, parsley, peas, yeast-based products, white flour and white sugar products in excess, also increase the vata dosha. Excessive use of fried foods, heavy creams and puddings increases kapha dosha. Gradual aggravation of vata and kapha dosha leads to blockage of artavavahi srota and causes Amenorrhoea.
Lifestyle Excess physical exercises, improper ways of intercourse, use of artificial objects for reaching orgasm, sedentary lifestyle, no exercises, excessive cold or warm temperature also leads to an imbalance of dosha. Gradual aggravation of vata and kapha dosha leads to blockage of artavavahi srota and leads to Amenorrhoea.
Samprapti (Pathogenesis) Let us see how this aggravated vata and kapha causes Amenorrhoea:
Aggravated vata or apana vata causes increase of digestive fire, impairing digestion at a subtle level. Impaired digestion causes accumulation of ama or toxins in the body. This ama leads to Amenorrhoea.
It is like this: The food that we eat is digested by the digestive fire and is converted into nutrient plasma (rasa dhatu). This nutrient plasma nourishes all other body tissues (dhatus) like blood (rakta dathu), muscles (mamsa), fat (meda), bones (asthi), bone marrow (majja), and reproductive fluid (shukra). This nourishment for production of various tissues is carried through a network of channels to various parts of the body. Artava or menstrual blood is a part of rasa dhatu or nutrient plasma.
When digestion is impaired, instead of the healthy nutrient plasma, ama or toxins are produced. This ama accumulates in weaker channels of the body. When this ama accumulates in rasavahi srota (which carries the nutrient plasma) or artavavahi srota (which carries the menstrual flow) and blocks them stopping the flow of menstruation, it can lead to Amenorrhoea. Aggravated kapha also causes low digestive fire (mandagani), impairing the digestion at subtle level. This causes accumulation of ama or toxins in the body. This ama leads to Amenorrhoea. The food that we eat is digested by the digestive fire and is converted into nutrient plasma (rasa dhatu). This nutrient plasma nourishes all other body tissues (dhatus) like blood (rakta dathu), muscles (mamsa), fat (meda), bones (asthi), bone marrow (majja), and reproductive fluid (shukra). This nourishment for production of various tissues is carried through a network of channels to various parts of the body. Artava or menstrual blood is a part of rasa dhatu or nutrient plasma.
When digestion is impaired, instead of the healthy nutrient plasma, ama or toxins are produced. This ama accumulates in weaker channels of the body. When this ama accumulates in rasavahi srota (which carries the nutrient plasma) or artavavahi srota (which carries the menstrual flow) and blocks them stopping the flow of menstruation, it can cause Amenorrhoea. Aggravated vata and kapha dosha increases the cold temperament in the body, which leads to low pitta dosha or decrease of hot temperament. Menstrual blood is analogous to pitta dosha. Thus, low pitta dosha or low hot temperament leads to decrease or loss of menstrual blood.
Doshas involved: High vata, kapha and low pitta
Srota involved: Rasavahi srota and artavavahi srota.
Diet: A diet, which will increase pitta and pacify vata and kapha, is advised. It should be nourishing and easy to digest. Follow a hot and spicy diet, which is astringent, acidic, with garlic, onion, nuts, ginger etc. Herbal teas are recommended. Spices like black pepper, cinnamon, coriander, cardamom, fennel, ginger, cumin, black pepper, fenugreek, clove, celery seed, salt, soya seed and mustard seed can be used for garnishing the foods. Milk and milk products are good. But avoid yoghurt, as it causes blockage of menstrual channels. Eating excessively cold, light, dry, or airy foods that increase vata dosha in the body should be avoided. Also resist from eating gas forming vegetables and fruits like cabbage, broccoli, cauliflower, beans, lettuce, mushrooms, parsley, peas, yeast-based products, white flour and white sugar products in excess, as they increase the vata dosha. Excessive use of fried foods, heavy creams, and puddings increases kapha dosha so should be avoided. For obese persons, an anti-kapha diet is recommended.
Dairy: Low-fat milk is recommended. Boil milk before drinking. Drink it warm. This makes it easier to digest. Do not take milk with a full meal or with sour or salty foods. Add a pinch of turmeric or ginger to the milk before boiling it. This helps to reduce the kapha increasing qualities of the milk. Fruit: Lighter fruits, such as apples, oranges, grape fruit, pineapple and papaya and pears, are recommended. Sweeteners: Honey is excellent for reducing kapha. Reduce the intake of sugar products, which increase kapha. Beans are recommended. Nuts should be avoided. Grains such as barley, chickpea and millet are recommended. Do not take too much wheat or rice, as they increase kapha. Spices are recommended as they decreases kapha. Vegetables such as sweet potatoes and root vegetables are good. Lifestyle: Follow a lifestyle that will increase pitta and pacify vata and kapha.Negative feelings like stress and tension should be avoided. Do not undertake physical or mental work beyond your capacity. Excessive intercourse should be avoided. Limit the use of contraceptives. Follow an active lifestyle, yet the exercises should be according to one's capacity. Both, excessive fasting and overeating are harmful. Smoking, drinking alcohol and using narcotics aggravates menstrual disorders.