Absence of menstruation. Amenorrhea may be primary (the girl has never begun her periods) or secondary (the woman had her periods once and then stopped having them). Physiologic amenorrhea is the lack of menses before menarche, during pregnancy and early lactation, and after menopause (all considered normal). All other causes of amenorrhea are pathologic.
Causes of Primary Amenorrhea
Physiologic Delay
The late onset of menses in a physiologically normal female. No workup is necessary in the female who has secondary sexual characteristics but no menstrual cycles until she is 18; however, if no secondary characteristics appear by age 14 and no menses has occurred, then a workup should be started earlier. The age of menarche of the mother will often provide clues as to when the female child should expect to begin.
Primary Ovarian Failure
These patients are divided into two groups: those with normal but infantile genitalia (e.g. Turner’s syndrome), and those with ambiguous genitalia (e.g. hermaphrodites). Karyotyping is necessary. Causes include: hypothalamic or pituitary failure (insufficiency or organic disease of either of those organs); congenital abnormalities (vaginal agenesis, vaginal septa, cervical atresia, uterine agenesis, uterine septi, or bicornuate uterus); imperforate hymen (this could impede the outflow of the menstruum. The girl will report monthly cyclical abdominal cramping due to the buildup of the menstrual flow. Treatment includes opening the hymen after a needle aspiration of the area behind the hymen demonstrates that a vagina exists).
Causes of Secondary Amenorrhea
Endometrial Sclerosis
This usually occurs as a result of a D&C after which the tissues heal by fibrosis.
Cervical Stenosis
This can occur after a cervical conization where the cervix scars or the os cannot be found. Intrauterine growths must be ruled out.
Anovulation
This may be sporadic or constant.
These can be causes for anovulation:
- Hypothalamic causes*: The organ disorder may be due to organic lesions (tumors, scars) or insufficiency (polycystic ovarian disease, hyperprolactinemia amenorrhea).
- Pituitary causes*: Including insufficiency (Sheehan’s syndrome) or organic disease (tumors, adenomas).
- Ovarian causes*: From scarring, tumors, cysts.
- Low Body Fat from Excess Exercise* (less than 10% body fat): Although this form of anovulation is similar to that which is induced with anorexia nervosa, in this type, when the patient regains weight or stops exercising excessively, the period will return.
- Adrenal Dysfunction: Hyperplasia, adenomas, tumors.
- Systemic Causes of Anovulation: Cushing’s disease; post oral contraceptive agent syndrome; hyperprolactinemia; both over and underactive thyroid problems; and other disease (ulcerative colitis, diabetes mellitus, steroid use for autoimmune diseases, celiac disease). Usually when these diseases are corrected the menses will return to normal.
*Indicates primary or secondary causes, usually secondary.
Contributing Factors
- Poor diet
- High stress
- Impaired fatty acid conversion
Consider Vitamin D Deficiency
Vitamin D deficiency appears to occur frequently in women with hormonal balance dysfunction such as PCOS, dysmenorrhea, endometriosis, and possibly fertility issues, and may be a contributing factor to some of the biochemical abnormalities seen in these conditions. In a study published in Steroids (1999; 64(6):430-435), of 13 women with PCOS, 5 were found to have frank vitamin D deficiency (serum 25-hydroxyvitamin D concentration <9 ng/mL) and 3 others had borderline-low vitamin D status. All 13 women were treated with vitamin D2 at a dose of 50,000 IU once or twice a week to maintain a serum 25-hydroxyvitamin D conentration of 30 to 40 ng/mL. Each woman also received 1500 mg of supplemental calcium per day. Of the 9 women with amenorrhea or oligomenorrhea prior to vitamin D treatment, 7 experienced normalization of their menstrual cycles within 2 months and the other 2 became pregnant. Dysfunctional uterine bleeding also resolved within 2 months in both women whom it had been present.
Vitamin D3 (the form of the vitamin produced in the human body after sunlight exposure) is at least 3.4 times as potent as vitamin D2 and may be as much as 9.4 times as potent according to a study published in J Clin Endocrinol Metab. (2004;89(11):5387-5391). Therefore, when supplementing with vitamin D3, lower doses than those administered in the aforementioned study should be used.
According to the Food and Nutrition Board of the Institute of Medicine, long-term vitamin D3 intake up to 5000 IU per day is unlikely to have any adverse effects in the general adult population.
Nutritional Support Considerations for Amenorrhea
- Dynamic Hormone Balance — Mix 1 scoop in 8-10 ounces of water once or twice daily (depending on severity of condition).
Dynamic Hormone Balance is a comprehensive blend of evidence-based ingredients that support healthy estrogen balance and endocrine function. This naturally flavored formula provides key herbal extracts, bioactive micronutrients, lignans, isoflavones, and antioxidants which have been shown in clinical settings to help balance healthy estrogen levels.
Proper estrogen balance is key for supporting healthy mood, well-being, energy levels, and a multitude of other functions in the body. As such, when estrogen is too low or too high, a variety of health issues can manifest.
– OR –
- Estro Balance — 2 capsules daily.
Estro Balance – Micronutrient and Herbal Support for Healthy Estrogen Balance Current research shows a possible connection between healthy stress response and healthy estrogen metabolism. NutriDyn’s latest innovative formula for
Estro Balance uses this connection to create a unique combination of ingredients that not only supports healthy estrogen balance, but also have a host of other health benefits.
Estro Balance is formulated with the latest bioavailable micronutrients, antioxidants, and phytoestrogens to support healthy molecular and cellular functions that balance estrogen metabolism for overall health and wellness.
Why Estro Balance? Biofolate®, Broccoli Raffinate, DIM, NAC, and HMR are backed by years of scientific research on how they each promote healthy stress response. The latest research also points to the possible benefits of these ingredients to support healthy estrogen metabolism. Estro Balance combines them into one product for overall health and wellness.
The new Estro Balance formula may also support a variety of other health concerns including:
- Endocrine Function
- Cardiovascular Health
- Healthy Stress Response
- Immune Function
- Primrose Oil — 3 softgels daily.
Primrose Oil provides gamma-linolenic acid (GLA). GLA is a precursor to the prostaglandin E1 series, which play an important role in supporting cellular health and maintaining overall good health. Promotes healthy cell membrane structure and helps maintain overall health. Helps to maintain healthy eicosanoid balance by providing GLA, a precursor of the important prostaglandin E1 series (PGE1).
- D3 5000 with K2 — 1 softgel daily with food. (higher dosing if documented by serum analysis)
D3 5000 with K2 is a highly bioavailable form of Vitamin D3—as cholecalciferol—and vitamin K2—as patented MenaQ7®. Vitamin D3 and Vitamin K2 are essential micronutrients with ubiquitous roles throughout the body, such as supporting stress levels, bone health, skin health, heart health, and immune function.
- Everyday Essentials Women’s — 1 packet daily.
Everyday Essentials Women’s is formulated to target your unique nutritional needs to help you stay active and vital and maintain overall health ins convenient daily packets.
“Your body requires a good balance of a wide variety of nutrients as more than one nutrient is required to support good health. When you have a lack in one part of the body, the whole body suffers. If there is a persistent lacking, your body will eventually suffer some form of degeneration or disease.”
Dietary Suggestions
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