Amenorrhea is the absence of menstrual cycles.
Amenorrhea is called primary when a woman has not started to menstruate by the age of 16 years, while secondary amenorrhea refers to the abnormal cessation of menstruation in a woman who previously has had menstrual cycles.1 In amenorrheic women, the levels of female reproductive hormones are not sufficient to stimulate menstruation. This condition is sometimes associated with malnutrition, such as that which occurs in anorexia nervosa, or with extreme exercise, which puts excessive nutritional and other demands on the body.2, 3 An association between stress and amenorrhea has also been demonstrated.4 Amenorrhea may also result from potentially serious disorders of the ovaries, the hypothalamus, or the pituitary gland; therefore, a physician should always evaluate chronic absence of menstrual cycles. Prolonged amenorrhea can result in early bone loss and increased risk of osteoporosis.5 Amenorrhea occurs naturally in women who are breast-feeding,6 but in these circumstances it does not put the bones at risk.7
Women with amenorrhea may have symptoms of absent periods, increased facial hair, decreased pubic and armpit hair, deeper voice, decreased breast size, and secretions from the breast.
Moderate exercise has many benefits to the overall health of premenopausal women, but intensive or excessive exercise can contribute to amenorrhea and increase the risk of early bone loss due to detrimental effects on hormone balance.8 Exercise typically increases bone density, but a study of dancers with amenorrhea found that bone density measurements remained below normal for the entire two-year duration of the study.9 The demands placed upon women performers and athletes are believed to contribute to the high incidence of eating disorders among them. This, along with the increased physical and nutritional demands of intensive exercise, can lead to nutrient deficiencies and lowered body-fat percentages that may contribute to amenorrhea and bone loss in women athletes.10, 11, 12 Running and ballet dancing are among the activities most closely associated with amenorrhea,13 with as many as 66% of women long-distance runners and ballet dancers experiencing amenorrhea.14 Among women bodybuilders in one study, 81% experienced amenorrhea, and many had nutritionally deficient diets.15 While some amenorrheic athletes have been reported to resume menstruation after adding one day of rest per week and consuming a daily nutritional beverage containing additional calories, protein, carbohydrate, fat, vitamins, and minerals,16, 17 no controlled trials have investigated this approach.
Hormonal changes associated with breast-feeding prevent menstruation in healthy women.18 The duration of this interruption in menstruation, known as lactational or postpartum amenorrhea, depends on many factors, including the nutritional health of the mother. Poor maternal nutritional status has been associated with longer periods of lactational amenorrhea in developing countries19, 20, 21, 22 as well as in Great Britain among poor nursing women.23 Better maternal nutritional status was found to be associated with shorter lactational amenorrhea in well-nourished nursing mothers in the United States.24 When malnourished nursing mothers are given food supplements, the length of lactational amenorrhea can be shortened, according to preliminary studies.25 However, one controlled trial found dietary supplementation with skim milk did not shorten the duration of amenorrhea in well-nourished nursing mothers.26 Although prolonged lactational amenorrhea prevents another pregnancy, it has not been shown to result in permanent bone loss.27
Excessive stress causes the body to produce increased amounts of the adrenal hormone cortisol, and several studies have linked high cortisol levels to low levels of reproductive hormones and to amenorrhea.28, 29, 30 In one study, amenorrheic women showed a greater increase in cortisol in response to stress than did women with normal menstrual cycles.31 No research has been done to evaluate stress reduction interventions for the treatment of amenorrhea.
Smoking may contribute to amenorrhea. A survey study found that young women smoking one pack or more per day were more likely to be amenorrheic than other women.32 However, whether smoking cessation will normalize menstrual function in amenorrheic women is unknown.
In a number of preliminary trials,33, 34, 35acupuncture has been shown to induce ovulation in women with disorders involving lack of ovulation. Preliminary studies show that levels of estrogen and progesterone, as well as levels of the related hormones LH (luteinizing hormone) and FSH (follicle-stimulating hormone), may all be affected by acupuncture.36, 37 Few studies have looked at the use of acupuncture for treatment of amenorrhea, but one preliminary trial found it helpful for women who have widely separated menstrual cycles.38 In one controlled trial, amenorrheic women showed a trend toward normalizing hormone levels following acupuncture.39
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The information presented in Aisle7 is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires June 2015.