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.

Naturopathic Approach

A naturopathic approach to treating someone with amenorrhea starts with determining the underlying cause(s). Most often in my practice, what I see as the underlying cause is estrogen insufficiency due to either low body fat weight or chronic adrenal stress which may too be accompanied with hypothyroidism. Nutritional support for the ovaries/adrenals/thyroid, along with ensuring optimal body composition are the most frequent interventions offered.