Amenorrhea can be divided into primary amenorrhea and secondary amenorrhea. When a woman did not get a period by age 16, then physicians call this primary amenorrhea. If a woman who has had previous normal menstrual periods fails to have periods for more than 3 months this is by definition called secondary amenorrhea.
Causes of amenorrhea
There are many causes of amenorrhea. It is always abnormal to have this condition and means that there is either a hormonal dysbalance or a physical abnormality of the vagina, uterus or the ovaries. The hormone dysbalance can be genetic as in the Turner syndrome. Physical abnormalities such as absence of uterus or vaginal tissue, narrowing of the cervical canal etc. are only a few of the possibilities apart from the big genetic abnormalities explained. A gynecologist needs to do a thorough work-up to pinpoint the cause of the amenorrhea. Depending on what the cause of amenorrhea therapy might be quite different for two patients who present with similar symptoms.
One of the common causes of amenorrhea is anovulation. In this condition there are functional ovarian follicles, but due to a hormonal dysbalance at the hypothalamic, pituitary level or due to another hormonal dysbalance such as thyroid hormone disorder, polycystic ovary syndrome or obesity (hyperinsulinism) the final stimulus to induce ovulation is missing. Some of these women need a work-up by an endocrinologist. A good start is to see a gynecologist who may want to do certain tests first and perhaps refer to further specialists, if necessary, later. Another physician, namely an anti-aging physician, may be able to help you. When this physician orders a saliva hormone screening test, the result may show that the patient has too much estrogen and not enough progesterone, a condition called “estrogen dominance” by Dr. Lee (Ref. 25).
Treatment is specifically directed at the cause of each case, which will differ according to the underlying condition. In the case of polycystic ovaries or estrogen dominance in association with obesity often simple bio-identical progesterone hormone replacement therapy will cure the problem (Ref.25).
1. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 235.
2. B. Sears: “Zone perfect meals in minutes”. Regan Books, Harper Collins, 1997.
3. Ryan: Kistner’s Gynecology & Women’s Health, 7th ed.,1999 Mosby, Inc.
4. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 245.
5. AB Diekman et al. Am J Reprod Immunol 2000 Mar; 43(3): 134-143.
6. V Damianova et al. Akush Ginekol (Sofia) 1999; 38(2): 31-33.
7. Townsend: Sabiston Textbook of Surgery,16th ed.,2001, W. B. Saunders Company
8. Cotran: Robbins Pathologic Basis of Disease, 6th ed., 1999 W. B. Saunders Company
9. Rakel: Conn’s Current Therapy 2001, 53rd ed., W. B. Saunders Co.
10. Ruddy: Kelley’s Textbook of Rheumatology, 6th ed.,2001 W. B. Saunders Company
11. EC Janowsky et al. N Engl J Med Mar-2000; 342(11): 781-790.
12. Wilson: Williams Textbook of Endocrinology, 9th ed.,1998 W. B. Saunders Company
13. KS Pena et al. Am Fam Physician 2001; 63(9): 1763-1770.
14. LM Apantaku Am Fam Physician Aug 2000; 62(3): 596-602.
15. Noble: Textbook of Primary Care Medicine, 3rd ed., 2001 Mosby, Inc.
16. Goroll: Primary Care Medicine, 4th ed.,2000 Lippincott Williams & Wilkins
17. St. Paul’s Hosp. Contin. Educ. Conf. Nov. 2001,Vancouver/BC
18. Gabbe: Obstetrics – Normal and Problem Pregnancies, 3rd ed., 1996 Churchill Livingstone, Inc.
19. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 251.
20. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 250.
21. Ignaz P Semmelweiss: “Die Aetiologie, der Begriff und die Prophylaxis des Kindbettfiebers” (“Etiology, the Understanding and Prophylaxis of Childbed Fever”). Vienna (Austria), 1861.
22. Rosen: Emergency Medicine: Concepts and Clinical Practice, 4th ed., 1998 Mosby-Year Book, Inc.
23. Mandell: Principles and Practice of Infectious Diseases, 5th ed., 2000 Churchill Livingstone, Inc.
24. Horner NK et al. J Am Diet Assoc Nov-2000; 100(11): 1368-1380.
25. Dr. John R. Lee, David Zava and Virginia Hopkins: “What your doctor may not tell you about breast cancer – How hormone balance can help save your life”, Wellness Central, Hachette Book Group USA, 2005. On page 253 and 254 he describes how progesterone can be used as a cream to treat fibroids.