Amenorrhea

Amenorrhea is an absence of the menstrual flow occurring at any time between Puberty and the menopause, except during pregnancy and lactation, when such a condition is physiological.

Classification based on cause:

1.      Physiological :

a.      During Pregnancy

b.      Sometimes during adolescence

c.      Before puberty

d.      After menopause

e.      Sometimes during lactation

2.      Pathological:

a.      Primary Amenorrhea: When the menarche does not appear even when the girl is over 18 years of age.

                                                i.     Cryptomenorrhea

                                               ii.     Rudimentary or infantile uterus or ovaries

                                             iii.     Congenital absence of uterus or ovaries

                                             iv.     Sex chromosomal defect

                                               v.     Endocrinal Causes- Hypothyroidism, Juvenile diabetes mellitus

                                             vi.     Injury or disease of Midbrain

                                            vii.     Frohlick’s Syndrome

                                           viii.     Tuberculosis, Anemia

                                             ix.     Poor Nutrition

                                              x.     Some drugs(Androgens)

b.      Secondary Amenorrhea: Cessation of menses for 3 or more months following normal menstruation-

                                                i.     Cervical Stenosis or amputation of cautery

                                               ii.     Uterine Injury, tuberculosis, Hysterectomy, radiation, D&C

                                             iii.     Bilateral Ovarian Tumor

                                             iv.     Premature Menopause

                                               v.     Bilateral oophorectomy

                                             vi.     Cushing Syndrome

                                            vii.     Acromegaly

                                           viii.     Phycological upset, anorexia nervosa, mental disease, worry, emotional shock

                                             ix.     Injury or disease to mid brain

                                              x.     Hypo or hyperthyroidism, Addison’s disease

                                             xi.     T.B , Kala-azar, Malaria, Typhoid fever, Diabetes, Alcoholism, Poor Nutrition, Obesity

                                            xii.     Certain drugs, contraceptive pills, androgens

Commonest cause of secondary amenorrhea is pregnancy.

Symptoms:

In chronic amenorrhea the symptoms are often only such as are characteristic of the pathological condition of which the amenorrhea itself is but a symptom  and are better considered  in connection with those conditions.

Acute suppression may give rise to symptoms which in character and intensity, will vary from those of ordinary menstruation- backache, heaviness and weight, pelvic pains to symptoms of profound disorder leading sometimes to severe and dangerous diseases.

Diagnosis:

The diagnosis of the amenorrhea is self-evident, but the diagnosis of the pathological condition which produces it is often a matter of difficulty and can only be accomplished by a thorough understanding of these respective states.

Investigations:

Causes of amenorrhea are to be remembered and the investigation is to be conducted accordingly.

1.      Complete Blood picture, Hb%, E.S.R, Cholesterol, Sugar

2.      Complete Urine Examination

3.      X- ray of chest and pituitary fossa

4.      Vaginal cytology

5.      Hormonal assays

6.      USG

Prognosis:

This depends on ability to remove existing cause and is usually favourable.

Homeopathic Remedies for Treatment of Amenorrhea:

ACONITE:

Fear that menses will not return and terrible consequences follow, labour like pressing in womb, patient bent double; tendency of head or chest complaints; vertigo or fainting on rising from recumbent position; amenorrhea in young plethoric girls who lead a sedentary life; menses stopped from cold bath; from sudden checking of perspiration; from violent emotion or fright; vagina dry, hot and sensitive.

CALCAREA CARBONICUM:

Especially useful in scrofulous or tuberculous subjects; fair pump girls, of a leuco-phlegmatic  temperament ; malnutrition; disturbances of indigestion; weary , languid, want of vitality; anaemia.

CIMICIFUGA:

In rheumatic, neuralgic, choreic,  or hysterical subjects; menses irregular, delayed or suppressed; ovarian irritation; uterine cramps; bearing down in uterine region and small of back, limbs heavy and torpid; suppression from cold and emotions; more generally useful in all classes of amenorrhea than other remedies.

FERRUM PHOSPHORICUM:

Anemia in weakly; chlorotic persons with fiery redness of face ;  sexual desire lessened; sterility, nervousness and debility; great disposition to keep quiet ; pale face, with blue margins around eyes; pressure in head and stomach; exophthalmic  goiter after suppression of menses.

GRAPHITIS

First menses delayed, or disturbances at the menopause. ‘’Graphitis is in climax what Pulsatilla is in youth’’. Menses late, scanty and pale; pain in the epigastric as if everything will be torn into pieces; patient inclined to obesity; induration of ovaries.

Other homeopathic remedies for Amenorrhea are Helonias, Pulsatilla, Phosphorus, Senecio, Sepia.

Biochemic Remedies useful for treatment of amenorrhea are Calcarea Phophorica, Kai Phosphorica, Kali Sulphuricum; Kali Muriaticum