Amenorrhea is the absence of menstruation. If menstruation has not begun by the age of 16 years, known as primary amenorrhea, and if menstruation has taken place but subsequently ceases for a period of 6 months or longer, known as secondary amenorrhea. The pathophysiology of amenorrhea can be defined by dysfunction at one of the levels of hypothalamic-pituitary-ovarian-uterine axis.

Causes of amenorrhea

Common causes of primary amenorrhea

• Ovarian pathology such as polycystic ovary and other related diseases
• Chromosomal aberrations with gonadal dysgenesis
• Vaginal and uterine abnormality
• Physiological delayed puberty
• Endocrinal causes such as Addison’s disease, hypothyroidism, adrenogenital syndrome
• Central disorders such as pituitary tumors, internal hydrocephalous
• Anorexia nervosa

Causes of secondary amenorrhea

Physiological causes including pregnancy, reduced diet, stress, and high-performance athletics

Disorders related to uterus (endometrial destruction due to an infection or extensive curettage after abortion or delivery

Hypothalamic- pituitary-ovarian axis (tumors, premature menopause, ovariectomy)

Other causes mainly include

• Hyperthyroidism
• Hypothyroidism
• Adrenal gland tumors
• Diabetes mellitus
• Contraceptive pills or agents
• Psychotropic drugs
• Exogenous androgens

Diagnosis of amenorrhea

Diagnosis of secondary amenorrhea

It is necessary that in all cases of secondary amenorrhea a detailed history should be taken followed by a careful examination. A complete menstrual history with special attention to the onset of amenorrhea, whether it is gradual or sudden and whether preceded by oligomenorrhea. In all cases of amenorrhea of short duration during the child bearing period, pregnancy should be excluded.  Psychological stress, severe dieting and weight loss associated with any environmental chances should be considered. History of tuberculosis, drug intake, contraceptive use, infection, previous pregnancy complications should be looked in to.

• Physical examination – physical examination mainly include
• Nutritional status – emaciation or extreme obesity
• Milk discharge from the breast
• Cervical adenitis or scar in the neck
• Presence of hirsutism, if any
• During a pelvic examination, any evidence of clitromegaly should be examined. Atrophic changes in the vaginal epithelium suggest premature ovarian failure. The size of uterus, and the presence of adnexal masses and their mobility should be ascertained.
• Special investigations to diagnose secondary amenorrhea
• Hemoglobin, total and differential counts and ESR
• Blood sugar to rule out diabetes
• Mantoux test for tuberculosis
• Endometrial histopathology following D/C for tubercular endometritis; culture for acid fast bacilli
• Vaginal cytology for hormonal status
• Hormonal estimation including T3, T4, TSH, FSH, LH, Testosterone
• USG of uterus and ovaries
• Laparoscopy to confirm sonographic findings
• Hysteroscopy to rule out endometrial tuberculosis and uterine synechiae
• X-RAY chest, X-ray of the skull, MRI may also be required in some cases
• GnRH stimulation test

Diagnosis of primary amenorrhea

Primary amenorrhea may be a symptom of many disorders. A thorough history and clinical examination has to be done. Relevant laboratory and other investigations including hormonal assays, karyotyping, pelvic ultrasonography, and diagnostic laparoscopy has to be done to confirm this.

Homeopathic treatment of amenorrhea  

Homeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach. This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering. The aim of homeopathy is not only to treat amenorrhea but to address its underlying cause and individual susceptibility. As far as therapeutic medication is concerned, several remedies are available to treat amenorrhea that can be selected on the basis of cause, sensations and modalities of the complaints.  For individualized remedy selection and treatment, the patient should consult a qualified homeopathic doctor in person. There are following remedies which are helpful in the treatment of amenorrhea:

• Aconite – suppression of menses in plethoric girls, fear and restlessness is well marked in girls.
• Calcaria carb – suppression of menses on girls, who are fat, swelling and tenderness during menses, headache, chilliness and colic before menses
• Apocynum – absence of menses in tropical conditions, dropsical swelling or distended abdomen, weakness and nervousness due to non appearance of menses
• Graphites – menses delayed and scanty or there is suppression of menses, usually associated with constipation
• Onosmodium – patient has feeling as if menses would appear soon but does not appear
• Opium –suppression of menses due to fright
• Cimicifuga – amenorrhea due to endocrinal disorders
• Phosphorous – remarkable remedy for amenorrhea, bleeding from nose, eyes instead of menses
• Causticum – menses during day only, ceases during night. Well known medicine for amenorrhea
• Apis Mel – amenorrhea or suppression of menses due to tumor in ovaries, acts well in young girls.
• Kali carb – delayed menses in young girls, suppression of menses from fright
• Lycopodium – amenorrhea in young girls with underdeveloped breasts, suppression of menses from fright.
• Colocynth – there is suppression of menses due to anger
• Ignatia – amenorrhea or suppressed menses; grief, changeable mood in females
• Pulsatilla – excellent remedy for amenorrhea, whatever the cause is this remedy acts remarkably
• Sepia – absence of menses after breastfeeding of child,
• Sulphur – too late menstruation, scanty and difficult menses, blood thick, black and excoriating
• Thyreoidinum – amenorrhea due to over activity of pituitary gland
• Pinus lamb. – Menses suppressed and delayed.