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by John Ryan Wahnish, D.Ac., L.Ac.

Western Overview and Approach

Amenorrhea is a menstrual condition characterized by absent menstrual periods for more than three monthly menstrual cycles. Amenorrhea may be classified as primary or secondary.

primary amenorrhea - The failure of menses to appear. Evaluation begins at age 14 if neither menarche nor breast development has occurred.

secondary amenorrhea - Due to some physical cause and usually of later onset; a condition in which menstrual periods which were at one time normal and regular become increasing abnormal and irregular or absent. Absence of menses for three consecutive months in who who have passed menarche.

There are several possible causes of amenorrhea, including the following:

Pregnancy
Women no longer ovulate when they are pregnant, thus, menstruation ceases temporarily.

Ovulation abnormality
Ovulation abnormalities are usually the cause of very irregular or frequently missed menstrual periods.

Birth defect, anatomical abnormality, or other medical condition
If a young woman has not started to menstruate by the age of 16, a birth defect, anatomical abnormality, or other medical condition may be suspected.

Eating disorder
Women with anorexia nervosa (or simply anorexia) and/or bulimia nervosa (or simply bulimia) often experience amenorrhea as a result of maintaining a body weight that would be too low to sustain a pregnancy. As a result, as a form of protection for the body, the reproductive system "shuts down" because it is severely malnourished.

Over exercise or strenuous exercise
Many young women athletes in training experience absent menstrual cycles due to low body fat content.

Thyroid disorder
In many cases, an under active thyroid gland (a condition called hypothyroidism in which the thyroid gland is producing insufficient amounts of the thyroid hormone) or an overactive thyroid gland (a condition called hyperthyroidism in which the thyroid gland secretes too much thyroid hormone -- resulting in too much thyroid hormone in the bloodstream and over activity of the body's metabolism) is responsible for the absent menstrual cycles.

Obesity
Women who are obese often experience amenorrhea as a result of excess fat cells interfering with the process of ovulation.

Diagnosis begins with a gynecologist evaluating a patient’s medical history and a complete physical examination including a pelvic examination. A diagnosis of amenorrhea can only be certain when the physician rules out other menstrual disorders, medical conditions, or medications that may be causing or aggravating the condition. In addition, a diagnosis of amenorrhea requires that a woman has missed at least three consecutive menstrual cycles, without being pregnant. Young women who have not had their first menstrual period by the age of 16 should be evaluated promptly, as making an early diagnosis and starting treatment as soon as possible is very important.

Western treatment for amenorrhea may include progesterone supplements (hormone treatment), oral contraceptives (ovulation inhibitors), and dietary modifications - to include increased caloric and fat intake. In most cases, physicians will induce menstruation in non-pregnant women who have missed two or more consecutive menstrual periods, because of the danger posed to the uterus if the non-fertilized egg and endometrium lining are not expelled. Without this monthly expulsion, the risk of uterine cancer increases.

TCM Overview

Amenorrhea: Menstrual block. No menstruation by age of sixteen is termed delayed menstruation. Primary: if no menses by age of 18. 40% of primary amenorrhea is Chromosomal. Secondary: if menses interrupted for three months or more. Other causes for interruption of the menses: 1.pregnany, 2. Menopause, 3. Breast-feeding, 4. Hysterectomy 5. Environmental. General Points: Du1, Empirical treatment: Sp10, St30, Ki1.

TCM Pattern Differentiation

Amenorrhea may present as one of these patterns or in combination. Other pattern maybe displaying depending on the individual.

Excess Patterns:

Qi Stagnation and Blood Stasis: most common.

Phlegm Damp Obstruction: primary or secondary

Vacuity Patterns:

Liver and Kidney Deficiency: primary

Yin Deficiency and Blood Dryness : secondary

Qi and Blood Deficiency: secondary

EXCESS

Qi Stagnation and Blood Stasis
Indications	Cessation of menstruation. Psychological depression, irritability, distention and fullness in the chest and costal region, lower abdominal distention, with pain that is aggravated by external pressure.
Tongue/Pulse	The tongue is dark, purplish; sometimes with stasis macules on body. the pulse is deep, wiry, or deep, rough.
Treatment Method	Rectify qi, quickens the blood, dispels blood stasis, frees menstruation.
Formulas	Xue Fu Zhu Yu Tang: House of Blood Stasis Expelling Decoction.
Point Prescription	Ren3, Sp8, Sp6, Li4, Lv3, Sp10, St29.

Phlegm Damp Obstruction
Indications	Cessation of menstruation, obesity, fullness and oppression in the chest and costal region, nausea and vomiting, excessive phlegm, tiredness, fatigue, excessive white vaginal discharge, edema of the face and feet. These patients can generally be overweight, possible PCO (Poly Cystic Ovaries).
Tongue/Pulse	The tongue has white greasy coat and the pulse is slippery.
Treatment Method	Expel phlegm, dispel dampness, rectify qi, quickens the blood, free menstruation
Formulas	Cang Fu Dao Tan Tang: Phlegm Abducting Decoction combined with Fo Shou San for PCO
Point Prescription	Ren3, Sp8, 6, St36, 40, Li4, Ren12, Sp6.

VACUITY

Liver and Kidney Deficiency
Indications	Absence of initial menstruation by 18 years of age, or late menstruation where the menstrual discharge gradually decreases to the point where menstruation does not occur; accompanying symptoms include weak physical constitution, lower backache, weakness of the legs, dizziness and vertigo. And tinnitus.
Tongue/Pulse	The tongue is pale red with little coating. The pulse is Deep, weak or rough, thready.
Treatment Method	Supplement the kidney, nourish the liver, regulates menstruation
Formulas	Gui Shen Wan Kidney Returning Decoction
Point Prescription	Ub17, 18, 23, Ren4, Sp6, moxibustion.

Yin Deficiency with Blood Dryness
Indications	General decrease in menstrual discharge until menstruation no longer occurs, vexing heat in the five hearts, flushed cheeks, dry mouth and throat, night sweating, steaming bone fever, in some cases, coughing with blood streaked phlegm.
Tongue/Pulse	The tongue is red a with a little coat. The pulse is rapid, thready.
Treatment Method	Nourish yin, clear heat, regulate menstruation
Formulas	Jia Jian Yi Yin Jian: Yin Boosting Variant Brew
Point Prescription	Ub17, 18, 23, Sp6, Ki3, Ub43

Qi and Blood Deficiency
Indications	Gradual lengthening of the menstrual cycle, light menstrual discharge of pale color and thin consistency, with the menses eventually ceasing. Accompanying symptoms include dizziness and vertigo, blurred vision, palpitations, SOB, tiredness, fatigue, loss of appetite, loose stools, loss of luster of the hair, (in some cases hair loss), emaciation, sallow complexion.
Tongue/Pulse	The tongue is pale with a white coating and the pulse is weak and thready.
Treatment Method	Supplement the qi, nourish the blood, regulate menstruation
Formulas	Ren Shen Yang Rong Tang (wan): Ginseng Construction Nourishing Decoction (pill)
Point Prescription	Ren4, Ub29 ,St36 ,Sp6, 10, moxibustion

Sources:

Wu, Yan. Practical Therapeutics of Traditional Chinese Medicine. Brookline Massachusetts: Paradigm Publications, 1997.

Maciocia, Giovanni. Obstetrics & Gynecology in Chinese Medicine. New York: Churchill Livingstone, 1999.

Tierney, McPhee, Papadkis. 2001 Medical Treatment and Diagnosis. New York: Lange Medical Books/McGraw-Hill, 2001.

Benskey, D., and Gamble, A.. Chinese Herbal Medicine: Materia Medica Revised Edition. Seattle: Eastland Press, 1993.

Benskey, D., and Barot, R.. Chinese Herbal Medicine: Formulas and Strategies. Seattle: Eastland Press, 1990.

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