If you are neither menopausal nor pregnant and have missed three periods in a row, you’re probably suffering from amenorrhea or an absence of menstruation and it would be wise to visit a health specialist for women or a doctor. If by the age of 16, a girl still hasn’t begun menstruation, she may be suffering from a type of amenorrhea known as “primary amenorrhea.” If a woman who has previously menstruated has ceased to menstruate for three months or more, and she is neither pregnant nor breastfeeding, she may be suffering from “secondary amenorrhea.”
Western Conventional Medicine’s Perspective on Amenorrhea
According to conventional Western medicine, a normal menstrual cycle is based on a complex feedback system between the ovaries, pituitary gland, and the hypothalamus as well as the cyclical response of the endometrium (the uterine wall) to sex hormones. The following conditions are suspected bring about primary amenorrhea:
Sex-chromosome problem and other ovarian disorders
Hypothalamic disorders such as gonadotropin-releasing hormone, adrenocorticotropic, or thyrotropic deficiency
The following dysfunctions are responsible for secondary amenorrhea:
Adrenal gland dysfunction
Several hormones can also contribute to the occurrence of amenorrhea. They include
Gonadotropin-releasing hormone (GnRH)
Luteinizing hormone (LH)
Follicle-stimulating hormone (FSH)
It is common for doctors to recommend hormone therapy to normalize menstrual cycles since irregularities in the menstrual cycle are so closely connected to hormone imbalances. To commence or resume the cycles, estrogen and progesterone are usually prescribed. If there has been no menstruation for more than six months, doctors will usually prescribe estrogen supplements to help women with no underlying disorder avoid the risk of osteoporosis. The most common form of estrogen replacement therapy is the birth control pill. And if hormone replacement therapy is your prescribed form of treatment, you need to know its long-term effects and side-effects as well as the functions of these hormones. This article will deal with Chinese medicine and its perspective and treatment approach to secondary amenorrhea.
Chinese Medicine and Amenorrhea
The Kidneys, Spleen, and Liver according to traditional Chinese medicine (TCM) are the most important organs that regulate menstruation and Blood and that Blood and Chi are the main Fundamental Substances in TCM. The organs that are responsible for conceiving, reproducing, and aging over time are the Kidneys. Menstrual blood originates from Kidney-essence. The Spleen’s primary function is to create Blood and Chi. A Spleen that is weak, will produce inadequate Blood and/or Chi, which means that there will be not enough Chi to regulate normal cycles and insufficient blood for normal menses. A weak Spleen can also result in Phlegm-Damp and Dampness in the body that can block the uterus. The organ that “stores the Blood,” is the Liver. Its other function is to maintain an even and smooth flow of emotions, Chi, and Blood through the body. Anxiety, resentment, irritation, anger and other strong emotions can cause Liver Chi to stagnate, that in turn, can result in Blood Stasis (particularly, in the lower body).
There are two patterns in TCM, by which amenorrhea is differentiated: Excess and Deficiency patterns. The Blood or Chi in Excess patterns may retain Phlegm-Dampness, or may stagnate, causing Blood Stasis or a blockage of menses. In a Deficiency pattern, the Blood is deficient or exhausted.
Besides the aforementioned mechanisms, amenorrhea can be caused by certain lifestyle factors. Longstanding intake of contraceptive pills can lead to Kidney Chi Deficiency or Blood Deficiency. Too much participation in sports or strenuous physical exercise that overuses the sinews and muscles can result in Liver and Spleen deficiency. This causes the Liver to store inadequate amounts of Blood and the Spleen to produce insufficient amounts of Blood that leads to amenorrhea.
Patterns of Secondary Amenorrhea in Chinese Medicine and Herbal Treatment of Amenorrhea
In secondary amenorrhea, four patterns of disharmony very commonly appear. Patterns of Deficiency such as Blood Chi Deficiency and Kidney Liver Deficiency are the first two patterns. In resolving these patterns, one needs to tonify the Deficiency. The Excess patterns are the other two patterns. They include Phlegm Dampness Retention and Chi Stagnation with Blood Stasis. To treat these two patterns, Chinese herbal medicines is used to eliminate the Excess. Factors that can cause an Excess pattern include an irregular sex lifestyle, Liver and Kidney malnourishment, general weakness, and Liver Kidney Deficiency. Symptoms may include palpitations; insomnia; hot flashes; excessive sweating; dream-disturbed sleep; dizziness; congestion in the chest; soreness in the knee and back; anxiety; cracks on the tongue or no tongue coating; amenorrhea for a considerable period of time; reddish tongue; and a thin, wiry, and rapid pulse.
Kidney Liver Deficiency
For Kidney Liver Deficiency, the most common herbs to tonify Liver Blood and Kidney-essence are Dang Gui (angelica), Shan Yao (root of dioscorea), and Shu Di Wang (Rehmannia). A tonic called Gui Shen Wan or Restoring Kidney Formula is an ideal herbal remedy that incorporates all those herbs.
Blood Chi Deficiency
The possible causes for this pattern may include prolonged breastfeeding; surgery; miscarriage; excessive bleeding from childbirth; and chronic illness. At the end of the cycle, menses usually become scantier and scantier, and ultimately stop completely. Other manifestations include: a thin-weak or thin wiry pulse; a thin pale tongue; loose stools; lassitude; weakness of the limbs; palpitations; dizziness; and a sallow complexion. The most widely-used herbal formula for this pattern is Ba Shen Tang or Chi Blood Tonic while Dang Gui (angelica) is used as a Blood tonic herb and Dang Shen or ginseng is the top Chi tonic herb.
Chi Stagnation and Blood Stasis
This pattern is commonly brought about by trauma or emotional stress. Menses ceases after longstanding or intense trauma or emotional stress. Symptoms include: thirst; fullness or swelling or of the stomach that worsens with pressure; purplish color on the sides of the tongue, with a sticky white yellow tongue coating; poor appetite; desire to drink cold water; depression; constipation; anxiety; amenorrhea; pulse that is deep-choppy or wiry thin; a fullness sensation under the rib cage and in the chest. Some of the popular herbs for this pattern include Bai Shao (white peony), angelica, and Chai Hu (Buplerum). A widely used herbal remedy to resolve this pattern is Hsiao Yao San or Liver Spleen Harmonizer.
Phlegm Dampness Retention
Factors that can cause this pattern include regular eating of dairy products, greasy foods, raw foods, and cold foods, Spleen deficiency, and being chronically overweight. Spleen Deficiency and being overweight can contribute to metabolism problems, and Phlegm Dampness retention can result in amenorrhea. Other symptoms include nausea; vomiting; lassitude; copious amounts of mucoid sticky vaginal discharge; tongue coating that is sticky yellowish white; a slippery thin pulse; sticky phlegm feeling in the mouth; a sensation of congestion and fullness in the lower rib cage and chest. The single herbs and herbal formula commonly used to address this pattern include Chen pi (tangerine peel), Hsiang fu (cyperus tuber), Cang shu ( atractylodes lancea tuber), and Cang Fu Dao Tan Tang or Phlegm Cleansing, respectively.
Apart from Chinese herbs, Chinese medicine also commonly uses moxibustion and acupuncture as healing tools for amenorrhea. Although the goal of both conventional Western medicine and traditional Chinese medicine (TCM) is to restore the menstrual cycle and restart the periods, there is a huge difference in the treatment approach of these two modes of treatment. TCM activates the body to normalize the body’s own hormones and restore their normal function. Western conventional medicine, on the other hand, uses artificial hormones to regulate the function of the ovary-pituitary-thalamus connection. The clinical study below reveals the very different long-term effects of these two therapeutic approaches.
In Jinan, China the Thousand Buddha Mountain Hospital conducted a clinical study to test the effectiveness of acupuncture for amenorrhea vis-à-vis drug therapy. The study involved the participation of 95 patients who all had amenorrhea caused by the use of birth control pills. Their condition has been lasting for six months or more. The participants were divided into two groups with 57 subjects designated to the acupuncture group and 38 subjects to the drug therapy group. Liver-Chi stagnation and Liver Spleen deficiency were the two patterns of amenorrhea differentiated in the acupuncture group. Moxibustion along with the needling of acupuncture points Ci Liao (Bl 32), San Yin Jiao (Sp 6), Da He ((Ki 12), extra point Zi Gong, and Shong Ji (Ren 3) were administered. For Liver Spleen Deficiency pattern Gong Sun (Sp 4), Hsu San Li (St 36), and Shen Shu (Bl 20) were included while acupoints Yin Ling Chuan (Sp 9), Chi Men (Liv 13), and Gan Shu (Bl 18) were added for Liver Chi Stagnation
The entire treatment consisted of six courses with 20 treatments equaling one course of treatment. There were five-day breaks in between the courses. At first Stilbestrol was given to the drug therapy group that was then later replaced with injections of Progesteronum. A month after the end of the treatments the acupuncture group’s rate of efficacy (cure, significant improvement, and improvement) was 96.5 percent, while that of the drug therapy group, 97.36 percent. So, in the beginning of the study, there was no significant statistical difference in the rate of effectiveness between the two groups. However, six months later post treatment the acupuncture group had an efficacy rate of 94.73 percent while the drug therapy group’s efficacy rate dropped to 78.95 percent. This substantial difference between the two treatments indicated that the long term long-range effects of acupuncture were very encouraging.
In China, a lot of studies conducted show that Chinese herbal medicine, moxibustion, and acupuncture lead to much greater benefits than Western conventional medicine when it comes to the treatment of amenorrhea and other menstrual disorders.