Amenorrhoea is the absence of the menstrual cycle during a woman’s reproductive years, excluding pregnancy and lactation. Primary amenorrhoea is the failure to start menstruation by the age of 16 years and is associated with developmental problems. Secondary amenorrhoea is more common, where menstruation ceases for three months or more after normal menstruation, for reasons other than pregnancy and lactation. Amenorrhoea, whether primary or secondary, is a symptom of some underlying cause, ranging from hormonal failure, physical obstruction, extreme stress (including over-exercise), metabolic dysfunction or hormonal imbalances. Many causes may overlap to cause secondary amenorrhoea, most commonly polycystic ovarian syndrome (PCOS), low body fat or major stress. Oligomenorrhoea on the other hand is characterised by infrequent or very scant menstruation. The cycle is longer than 35 days, and may occur as little as four times per year.
Amenorrhoea and oligomenorrhoea may be symptoms of:
- Pregnancy or lactation (amenorrhoea)
- Hormonal contraception; oral contraceptive pill use or progesterone therapy
- Excessive stress
- Low body fat mass (e.g. associated with eating disorders, excessive exercise or athleticism)
- Polycystic ovarian syndrome (PCOS)
- Pituitary tumours
- Some medical therapies; for example, chemotherapy
Stress is by far the most common reason for amenorrhoea and/or oligomenorrhoea. Excessive and/or chronic stress may suppress reproductive function. Elevated stress hormones interfere with hormones which regulate ovulation and menstruation. Subsequent low oestrogen and progesterone production may lead to anovulation and lack of menstruation.
Low levels of body fat may also contribute to amenorrhoea and/or oligomenorrhoea. Body fat is critical to healthy oestrogen metabolism. Low body fat may cause primary amenorrhoea, where menstruation fails to start, or secondary amenorrhoea, as a result of excessive exercise and/or dieting.
High levels of exercise may contribute to amenorrhoea and/or oligomenorrhoea as it both increases stress hormone production and reduces body fat levels. It is estimated that up to 20% of female athletes experience exercise-induced amenorrhoea. Due to the competitive nature of sport it may be difficult to separate this entirely from low body fat induced amenorrhoea, and the metabolic effects of stress, as both often occur together. In women who exercise intensely, there may be a resultant drop in oestrogen and progesterone levels, causing anovulation and amenorrhoea.
Excessive exercise and low body fat induced amenorrhoea is characterised by oestrogen deficiency, similar to menopause, leading to increased risks of calcium loss and early osteoporosis. Athletes with amenorrhoea are three times more likely to suffer from stress fractures, and are more likely to be infertile. For this reason, persons with anorexia nervosa are also more susceptible to osteoporosis.
At Nurtura Health, our dedicated Naturopaths utilise herbal and nutritional formulas specifically indicated for the support of healthy reproduction and ovarian function in women. Herbs have a strong traditional use to support female reproductive function in women who have low oestrogen levels and annovular cycles and may assist in regulating menstruation, supporting female fertility and maintaining normal healthy sexual desire and function in women with low oestrogen levels. This approach is particularly useful for female persons trying to conceive in their late 30’s/early 40’s.
Watch this space for future posts on other conditions in more detail!Disclaimer: The advice on this website is of a general nature only and Nurtura Health expressly disclaims all liability arising out of the improper use of the information provided. Nurtura Health actively discourages any self-diagnosis or self-medication. Please consult your health practitioner regarding these important health issues. All rights reserved.