Amenorrhea is the absence of menstruation. When a girl reaches age 16 and has not begun menstruating, she may have primary amenorrhea. When a woman who has had menstrual cycles misses three periods in a row, she is considered to have secondary amenorrhea. A hormone imbalance can cause hypoestrogenemic amenorrhea.

Symptoms sometimes related to primary amenorrhea include headaches, abnormal blood pressure, vision problems, acne, excessive hair growth, and perhaps either a short, stubby physique or extremely tall stature.

Symptoms sometimes related to secondary amenorrhea include nausea, swollen breasts, headaches, vision problems, unusual thirst, goiter (an enlarged thyroid gland), skin darkening, extreme weight loss, alcoholism, liver disease, and kidney failure. Hot flashes, mood changes, depression, and vaginal dryness are common with estrogen deficiency.

Generally, the causes of amenorrhea include certain genetic defects, body structure abnormalities, or endocrine disorders. Specific causes include the following.

• Developmental problems, such as the absence of the uterus or vagina
• Hormone imbalance produced by the endocrine system
• Excessive amounts of the male hormone testosterone
• Improper functioning of the ovaries
• Intrauterine infection or endometritis
• Menopause, usually between the ages of 40 and 55
• Pregnancy or breast-feeding
• Discontinuation of oral contraceptives
• Disease (such as diabetes mellitus or tuberculosis)
• Stress or psychological disorders
• Malnutrition, extreme weight loss, anorexia nervosa
• Extreme overweight (obesity)
• Extreme exercise (such as long-distance running)
• Drug abuse

Your provider will conduct a physical examination, which will include an internal pelvic examination. Laboratory tests may include analysis of mucus from the cervix and uterus, blood tests, computer assisted tomography (CAT) scan, magnetic resonance imaging (MRI), or ultrasound.

Your healthcare provider will treat your condition based on the underlying cause. Treatments include hormone therapy, psychological counseling and support, and surgery among others.

Your provider may suggest the following drugs:

• Oral contraceptives or hormones to cause menstruation to start
• Estrogen replacement for low levels of estrogen caused by ovarian disorders, hysterectomy, or menopause; greatly reduces risk of cardiovascular disease and inhibits osteoporosis; conjugated estrogens 0.625 to 1.25 mg per day; or on days 1 to 25 of calendar month (0.3 mg per day prevents bone loss). Women with an intact uterus should receive progestin (medroxyprogesterone acetate (MPA), a progestin, is given 5 to 10 mg per day on days 16 to 25 of calendar month to reduce risk of estrogen-induced endometrial cancer)
• Progesterone to treat ovarian cysts and some intrauterine disorders
• Alternative estrogen replacement: includes ethinyl estradiol (20 or 50 mcg); estradiol (0.5, 1, 2 mg); Selective Estrogen Receptor Modulators (SERMs) such as raloxifene if individual refuses estrogen but is at-risk for osteoporosis

Alternative therapies may help the body metabolize hormones while ensuring that the nutritional requirements for hormone production are met.

Eat fewer refined foods and limit animal products. Limit the cruciferous family of vegetables (cabbage, broccoli, brussel sprouts, cauliflower, kale). Eliminate methylxanthines (coffee, chocolate). Eat more whole grains, organic vegetables, and omega-3 fats (cold-water fish, nuts, and seeds). In addition, you may take the following supplements.

• Calcium (1,000 mg per day), magnesium (600 mg per day), vitamin D (200 to 400 IU per day), vitamin K (1 mg per day), and boron (1 to 3 mg per day).
• Iodine (up to 600 mcg per day), tyrosine (200 mg one to two times per day), zinc (30 mg per day), vitamin E (800 IU per day), vitamin A (10,000 to 15,000 IU per day), vitamin C (250 to 500 mg two times per day), and selenium (200 mcg per day).
• B6 (200 mg per day) may reduce high prolactin levels.
• Essential fatty acids: Flaxseed, evening primrose, or borage oil (1,000 to 1,500 mg one to two times per day).

Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day.

• Chaste tree (Vitex agnus-cactus) helps normalize pituitary function but must be taken for 12 to 18 months. Use under the supervision of your provider if you take hormone therapy.
• Black cohosh (Cimicifuga racemosa), licorice (Glycyrrhiza glabra), and squaw vine (Mitchella repens) help to balance estrogen levels. Do not take licorice if you have high blood pressure.
• Chaste tree, wild yam (Dioscorea villosa), and lady's mantle (Alchemilla vulgaris) help balance progesterone levels.
• Kelp (Laminaria hyperborea), bladderwrack (Fucus vesiculosus), oatstraw (Avena sativa), and horsetail (Equisetum arvense) are rich in minerals that support the thyroid.
• Milk thistle (Silybum marianum), dandelion root (Taraxacum officinale), and vervain (Verbena officinalis) support the liver.

Homeopathy may be useful as a supportive therapy.

The following help increase circulation and relieve pelvic congestion.

• Castor oil pack. Apply oil to skin of abdomen, cover with a clean soft cloth and plastic wrap. Place a hot water bottle or heating pad over the pack and let sit for 30 to 60 minutes. Use for three days.
• Contrast sitz baths. Use two basins that you can comfortably sit in. Sit in hot water for three minutes, then in cold water for one minute. Repeat this three times to complete one "set." Do one to two sets per day, three to four days per week.

Acupuncture is believed to improve hormonal imbalances that can be associated with amenorrhea, and related conditions such as polycystic ovary syndrome (PCOS). A few small studies of women with fertility problems (which are sometimes connected with amenorrhea) suggest that acupuncture may help promote ovulation. Acupuncturists treat people with amenorrhea based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. Acupuncturists believe that amenorrhea is generally associated with liver and kidney deficiencies and treatment often focuses on strengthening function in these areas.

Therapeutic massage may improve endocrine function by relieving stress.

Becoming pregnant may be difficult or impossible. Amenorrhea also may cause pregnancy complications.

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