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Missing periods, which is known as "Amenorrhoea" is defined as the absence of a menstrual bleed. It is crucial to note that amenorrhoea is a symptom of another condition, not a diagnosis. To rebalance your wearied hormones, diagnosing the type and cause of amenorrhoea is essential.
WORDS Katie Gregory
Amenorrhoea can be broken down into two groups; primary and secondary.
Primary amenorrhea is when a female displays natural sexual characteristics but has still not begun her menstrual cycle by the age of 16. However, if sexual characteristics have not begun by 14 years old, and a female doesn’t have her menstrual cycle by 16, this too should be further investigated. Causes can be due to genetic anomalies, structural defects, or can be due to issues with the hypothalamus, pituitary glands or ovaries.
Secondary amenorrhea is defined when a woman who has previously had a menstrual cycle hasn’t had a menstrual bleed for a minimum of three months.
Common causes of secondary amenorrhea:
First and foremost pregnancy should be ruled out, as well as breastfeeding or menopause.
Post- pill (COCP) amenorrhoea- Menstruation can be difficult to resume following cessation of the pill. Many women may have been masking symptoms of conditions such as PCOS whilst on the pill. Chances are, if you had issues with your cycle before the pill, the issues will remain.
Polycystic ovarian syndrome (PCOS) is one of the most common conditions linked to failure to ovulate. Absence of menstruation is a common symptom in PCOS.
Thyroid imbalance- Both an under or over active thyroid can contribute to lack of ovulation and amenorrhea. If you are experiencing an absent cycle, it would be wise to get your thyroid levels checked (not just your TSH). It is important to investigate T3, T4, reverse T3 and antibodies to check for irregularities.
Functional hypothalamic amenorrhoea (FHA)- This is the absence of menstruation in a non-pregnant female who has previously had a regular menses who does not have any other drug, anatomical, medical or endocrine cause for the lack of a menstrual cycle.
FHA can be caused by: weight loss/malnutrition or disordered eating, excessive exercise, chronic illness, drug use (both recreational and psychotropic medications), severe stress or depression. If you have been unkind to your body, notice what shifts you can make to nurture and restore her.
Asherman’s syndrome- This is where adhesions or fibrotic tissue are present in the uterine cavity following a trauma (this can occur following a dilation and curettage, C-section, pelvic infections, or cancer radiation treatment).
Medications such as antipsychotics or anti-hypertensives can affect hormone levels and cause amenorrhea. Please note, if you suspect your medication may be contributing to your lack of menses- discuss this with your healthcare professional(HCP). Cessation of any medication must be done under the guidance of your HCP.
By determining the cause of your absent cycles, appropriate treatment can begin and your cycle will have the ability to return. Hormones take time to repair and it is important to allow a minimum of 3-6 months to reestablish your cycle.
Supporting the return of your cycle:
Visit your general practitioner, gynecologist or naturopath to do further investigations into why you are not menstruating. Some tests to consider are: complete hormone testing, thyroid profile, iron studies, coeliac serology, plasma zinc, vitamin D, full blood count and liver function tests.
Reduce high intensity exercise. Whilst moving the body is good, now is the time to lean into restorative movement such as yin yoga, bush walking, or gentle stretching. For some, limiting to meditation and breathwork is enough.
Include zinc rich foods in the diet, you need zinc to make hormones and zinc is required for all parts of the reproductive process. Zinc rich foods include: cashews, oysters, mushrooms, pumpkins, spinach, lentils and walnuts, and hemp seeds. Typically, vegetarian/vegans are low in zinc as zinc is often found in high amounts in animal products.
Nourish your body with regular meals and snacks focusing on a mix of protein, healthy fats, and complex carbohydrates. If you have a poor relationship with food & eating, seek the guidance and support from a counsellor or psychologist well versed in this, alternatively The Butterfly Foundation has wonderful resources for those who are experiencing disordered eating.
Depending on the cause of amenorrhoea, herbal medicines may be beneficial in restoring balance to the menstrual cycle. Herbs such as Vitex, Peony, Tribulus, Withania, Licorice, Dong Quai, or Shatavari may all be considered to stabilize hormonal function and revive a weakened menstrual cycle.
Whilst exploring plant medicines, and causes of imbalances within your health, before making any changes to your diet, medication or beginning any herbal or nutritional supplements it is vital to consult your G.P, naturopath, health care professional for personalised guidance and advice.
