Amenorrhoea is defined as absence of menstrual cycle in a female of reproductive age group.
Onset of menses is delayed by age of 16 years in young girls is defined as primary amenorrhoea. Absence of menses for more than 3 months in women with previously regular cycles and absence of menses for 6-9 months in a women with previous irregular cycle is defined as secondary amenorrhoea.
Amenorrhoea is not a disease it is a symptoms of underlying disorders result in absence of menses.
AMENORRHEA – Homeopathy Treatment & Homeopathic Remedies
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:
- Senecio aureus
- Apis mellifica
- Ferrum metallicum
- Calcarea phos
- Lilium tig
- Conium maculatum
- Kali carb
- Amenorrhoea, Suppressed menses from wet feet, nervous debility, or chlorosis.
- Tardy menses. Too late, scanty, thick, dark, clotted, changeable, intermittent.
- Chilliness, nausea, downward pressure, painful, flow intermits.
- Leucorrhoea acrid, burning, creamy.
- Pain in back; tired feeling.
- Diarrhoea during or after menses.
- Patient Weeps easily. Timid, irresolute.
- Fears in evening to be alone, dark, ghost.
- Likes sympathy.
- Its action on the female organism has been clinically verified. Urinary organs also affected in a marked degree.
- Menses retarded, suppressed.
- Functional amenorrhea of young girls with backache.
- Before menses, inflammatory conditions of throat, chest, and bladder. After menstruation commences, these improve.
- Anaemic dysmenorrhoea with urinary disturbances.
- Has a wide action upon the cerebrospinal and muscular system, as well as upon the uterus and ovaries.
- Pain in ovarian region; shoots upward and down anterior surface of thighs.
- Pain immediately before menses.
- Menses profuse, dark, coagulated, offensive with backache, nervousness; always irregular.
- Ovarian neuralgia. Pain across pelvis, from hip to hip.
- After-pains, with great sensitiveness and intolerance to pain.
- Infra-mammary pains worse, left side.
- patients who are rather stout, of fair complexion, with tendency to skin affections and constipation, fat, chilly, and costive, with delayed menstrual history.
- Menses too late, with constipation; pale and scanty, with tearing pain in epigastrium.
- Hoarseness, coryza, cough, sweats and morning sickness during menstruation.
- Leucorrhśa, pale, thin, profuse, white, excoriating, with great weakness in back.
- Mammae swollen and hard.
- Induration of ovaries and uterus and mammae.
- Nipples sore, cracked, and blistered.
- Decided aversion to coitus.
- Menses suppressed, with cerebral and head symptoms, especially in young girls.
- Dysmenorrhoea, with severe ovarian pains.
- Bearing-down, as if menses were to appear.
- Ovarian tumors, metritis with stinging pains.
- Great tenderness over abdomen and uterine region.
- Patient with Apathy, indifference, and unconsciousness. Awkward; drops things readily.
- Jealously, fright, rage, vexation, grief. Cannot concentrate mind when attempting to read or study.
other medicines include-
- 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
- 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
- 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
- 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.
Classification of Amenorrhea
Onset of menses is delayed by age of 16 years in young girls is defined as primary amenorrhoea
Causes of primary amenorrhea
Patients with normal puberty but structural abnormality –
- Mullerian agenesis – A congenital malformation in which there is failure of development of mullerien duct responsible for development of female genital organ.
- Vaginal atresia – vagina is abnormally closed or absent.
- Cryptomenorrhoea/ Imperforate hymen – is a condition where menstruation occurs but is not visible due to an obstruction of the outflow tract. Hymen is imperforate and do not allow the menstrual flow to come out. Patient feels cyclic pain and discomfort without any menstrual discharge.
Patients with growth delay and developmental retardation
Gonads receive signals from pituitary gland in the form of FSH and LH to release sex hormone and pituitary receives signals from hypothalamus in the form of GnRH (gonadotropin releasing hormone). This is called hypothalamus-pituitary-ovarian axis.
- Hypergonadotropic hypogonadism – signaling from hypothalamus and pituitary gland is normal but gonad are not able to produce sufficient quantity of sex hormone for normal functioning of sex organs.
- Hypogonadotropic hypogonadism – There is disturbance in signaling either from hypothalamus or pituitary i.e. disturbance in releasing hormones from hypothalamus or pituitary, due to which gonads cannot receive enough signals to produce sufficient quantity of sex hormones.
Patients with virilization – increase amount of male sex hormones in female. This causes development of male secondary sexual characters in female.
- Congenital adrenal hyperplasia (CAH) – adrenal gland is a pair of endocrine produces sex steroids. Androgens are male hormones produced by adrenal gland. Hyperplasia of adrenal gland results in over production of androgens.
- Polycystic ovary syndrome (PCOS) – Disturbance in releasing of female sex hormones and increase amount of male hormone leads failure of development of egg each month in ovary result in amenorrhea.
Absence of menses for more than 3 months in women with previously regular cycles and absence of menses for 6-9 months in a women with previous irregular cycle is defined as secondary amenorrhoea.
Related to genital organs
- Pregnancy → most common cause of secondary amenorrhea
- Menopause – It is the physiological cessation of menses around age of 45-50 years.
- Premature menopause
- Polycystic ovary syndrome (PCOS) – Disturbance in releasing of female sex hormones and increase amount of male hormone leads failure of development of egg each month in ovary result in amenorrhea. PCOS may affect a women at any age of her reproductive life, hence amenorrhea because of PCOS may be primary or secondary.
- Celiac disease
Related to Hypothalmic-pituitary-ovarian axis
- Exercise amenorrhoea – related to physical exercise,
- Stress amenorrhoea,
- Eating disorders and weight loss (obesity, anorexia nervosa, or bulimia)
Diagnosis of Amenorrhea
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.
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