Amenorrhoea Treatment with Homoeopathy: Safe & Effective Natural Solutions

Amenorrhea refers to the absence of menstruation for a defined period. It is a symptom, not a disease.

Types of Amenorrhea

1. Physiological Amenorrhea

Occurs naturally in:

• Prepubertal phase
• During pregnancy
• Lactation
• Postmenopausal phase

2. Pathological Amenorrhea

Divided into:

• Primary Amenorrhea: Absence of menstruation by 16 years of age with normal secondary sexual characteristics or by 14 years if no secondary sexual development.
• Secondary Amenorrhea: Cessation of menstruation for three or more cycles in a woman with previously normal menstruation.

 Etiology (Causes) of Amenorrhea

1. Hypothalamic Causes

• Hypogonadotropic Hypogonadism
• Constitutional Delay
• Chronic illness (malnutrition, tuberculosis, diabetes, renal failure)
• Anorexia nervosa & extreme weight loss
• Intense exercise (Athletic Amenorrhea)
• Kallmann Syndrome (Hypogonadotropic Hypogonadism with Anosmia)

2. Pituitary Causes

• Hyperprolactinemia (Increased prolactin inhibits GnRH secretion)
• Prolactinoma (Pituitary Adenoma)
• Sheehan’s Syndrome (Postpartum Pituitary Necrosis)
• Cushing’s Disease
• Empty Sella Syndrome
• Hypopituitarism (Deficiency of gonadotropins FSH & LH)

3. Ovarian Causes

• Primary Ovarian Failure (Hypergonadotropic Hypogonadism)
• Turner Syndrome (45, X0 karyotype, streak ovaries, short stature)
• Pure Gonadal Dysgenesis (46, XX or 46, XY karyotype)
• Resistant Ovary Syndrome (Savage Syndrome)
• Premature Ovarian Failure (POF) – Ovarian failure before 40 years
• Polycystic Ovarian Syndrome (PCOS)
• Chronic anovulation, hyperandrogenism, insulin resistance

4. Uterine & Outflow Tract Causes

• Congenital Malformations
• Müllerian Agenesis (Mayer-Rokitansky-Küster-Hauser Syndrome) – Absent uterus & upper vagina with normal ovaries
• Imperforate Hymen or Transverse Vaginal Septum – Causes cryptomenorrhea (Menstrual blood trapped in uterus or vagina)
• Acquired Causes
• Asherman’s Syndrome – Endometrial scarring due to repeated curettage or infections (TB)

5. Endocrine Causes

• Hypothyroidism (Increased TRH → Increased Prolactin → Suppresses GnRH)
• Hyperthyroidism
• Cushing’s Syndrome (Excess Cortisol Inhibits GnRH)
• Congenital Adrenal Hyperplasia (CAH)
• 21-hydroxylase deficiency → Increased Androgens → Anovulation

Clinical Features of Amenorrhea

·        Primary Amenorrhea

• No menarche by 16 years
• No secondary sexual characteristics (breast development, pubic hair)
• Short stature, webbed neck (Turner Syndrome)

·        Secondary Amenorrhea

• History of normal menstrual cycles before cessation
• Weight loss, excessive exercise
• Galactorrhea (in Hyperprolactinemia cases)
• Hirsutism, acne (PCOS cases)

Investigations for Amenorrhea

1. General Blood Tests

• Complete Blood Count (CBC)
• Thyroid Function Tests (T3, T4, TSH)
• Fasting Blood Sugar (For PCOS, Diabetes Screening)

2. Hormonal Assays

• Serum FSH, LH → Ovarian Failure (High FSH & LH in Primary Ovarian Insufficiency)
• Serum Prolactin → Hyperprolactinemia (>100 ng/mL in Prolactinoma)
• Serum Testosterone & DHEAS → PCOS, Androgen-Secreting Tumors
• Serum Estradiol (E2) → Ovarian Function

3. Imaging Studies

• Pelvic Ultrasound – Detects uterus, ovaries, endometrial thickness
• MRI Brain – Detects pituitary tumors (Prolactinoma, Sheehan’s Syndrome)
• Karyotyping (Chromosomal Analysis) – Turner Syndrome (45, X0), Androgen Insensitivity Syndrome (46, XY)

4. Special Tests

·        Progestin Challenge Test (PCT)

• Positive (Withdrawal Bleed) – Indicates anovulation (PCOS)
• Negative (No Bleed) – Indicates Endometrial or Outflow Tract Abnormality

·        Estrogen + Progestin Challenge Test

• No Bleeding – Suggests Asherman’s Syndrome, Müllerian Agenesis

·        Hysteroscopy / Hysterosalpingography (HSG)

• Detects endometrial scarring (Asherman’s Syndrome), uterine abnormalities

Management & Treatment

1. Treatment Based on Underlying Cause

·        Hypothalamic Amenorrhea (Weight Loss, Exercise-Induced)

• Nutritional Rehabilitation
• Reduction of physical stress (Exercise Moderation)
• Cognitive Behavioral Therapy (CBT) for Eating Disorders

·        Hyperprolactinemia (Prolactinoma, Increased Prolactin)

• Dopamine Agonists (Cabergoline, Bromocriptine)
• Transsphenoidal Surgery for Large Pituitary Tumors

·        Ovarian Failure (Turner Syndrome, POI)

• Hormone Replacement Therapy (HRT) – Estrogen + Progesterone
• Egg Donation (For Pregnancy)

·        Polycystic Ovarian Syndrome (PCOS)

• Lifestyle Modification (Weight Loss, Exercise, Diet)
• Oral Contraceptive Pills (OCPs) – Regulate Menstrual Cycles
• Metformin – For Insulin Resistance
• Clomiphene Citrate – Ovulation Induction (For Infertility)

·        Müllerian Agenesis (MRKH Syndrome, Absent Uterus)

• Vaginal Dilators (For Functional Vagina Creation)
• Surgical Neovagina Creation (McIndoe Vaginoplasty, Vecchietti Procedure)

·        Asherman’s Syndrome (Endometrial Scarring)

• Hysteroscopic Adhesiolysis
• Estrogen Therapy to Regrow Endometrium

Complications of Amenorrhea

• Infertility (Anovulation, Ovarian Failure)
• Osteoporosis (Low Estrogen Levels)
• Endometrial Hyperplasia (Unopposed Estrogen in PCOS)
• Psychological Impact (Depression, Anxiety, Stress

Keynote Symptoms of Amenorrhea

1.    Absence of menstruation for more than three months in a previously regular cycle (secondary amenorrhea) or failure to start menstruation by age 16 (primary amenorrhea).

2.    Hormonal imbalances causing delayed puberty or menstrual suppression.

3.    Associated symptoms like weight gain, hirsutism, acne (in PCOS cases).

4.    Fatigue, mood swings, and headache due to hormonal deficiencies.

5.    Cyclic pelvic pain without menstrual flow (suggestive of an obstructive cause).

1. Pulsatilla

Indications:

• Suppressed menses due to emotional stress, cold exposure, or hormonal imbalances.
• Delayed or scanty menses, often accompanied by mood swings and weepiness.

Keynote Symptoms:

• Irregular, changeable menstrual cycle.
• Suppression of menses due to stress or grief.
• Feels better in fresh air, worse in warm rooms.
• Weepy, mild, and affectionate nature.
• Desire for fatty foods but aversion to warm drinks.

2. Sepia

Indications:

• Amenorrhea due to hormonal dysfunction, particularly in PCOS cases.
• Menses absent or very light with bearing-down sensation in the pelvis.

Keynote Symptoms:

• Indifference to family and relationships.
• Bearing-down sensation in the lower abdomen.
• Aversion to sex due to hormonal imbalance.
• Symptoms worsen in cold air, improve with vigorous exercise.
• Chloasma (brown facial discoloration).

3. Graphites

Indications:

• Scanty or absent menses due to metabolic disorders like obesity or hypothyroidism.
• Accompanied by constipation, dry skin, and cold intolerance.

Keynote Symptoms:

• Late, scanty, or suppressed menses with obesity.
• Dry, rough skin with eczema tendencies.
• Constipation with hard stools.
• Swelling and tenderness of breasts before periods.
• Depression, sadness, and low energy levels.

4. Calcarea Carbonica

Indications:

• Amenorrhea due to delayed puberty or hypothyroidism.
• Profuse sweating and sluggish metabolism.

Keynote Symptoms:

• Profuse sweating on the head during sleep.
• Cold, damp feet with a tendency for weight gain.
• Easily fatigued, sluggish metabolism.
• Craving for eggs and indigestible substances.
• Anxiety about health and fear of losing control.

5. Senecio Aureus

Indications:

• Delayed menses in young girls with anemia and urinary disturbances.
• Amenorrhea with a sensation of fullness in the pelvis.

Keynote Symptoms:

• Feeling of fullness in the bladder and pelvis.
• Amenorrhea with constant urge to urinate.
• Anemia, weakness, and pale complexion.
• Menstrual suppression after illness.
• Improves urinary flow and normalizes menstrual function.

Releted Therapeutics 

Menstrual troubles

Displacement of uterus

Sterlity