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VERIFIED CONTENTAuthor: Dominika Wilk

Loss of menstruation is a very common problem in young women. It is influenced by many different factors. Fortunately, a proper lifestyle, diet and pharmacology are able to restore the hormonal balance and help regain a lost menstrual cycle. What are the causes of amenorrhea and how to restore it?

We speak of secondary amenorrhea when it does not occur for the next 3-6 months. One of the most common causes of a missed period is pregnancy. However, apart from it, the cause of menstrual failure may be various diseases, e.g. diabetes, polycystic ovary syndrome, hyperprolactinemia, taking certain medications, eating disorders, or excessive and too intense exercise.

Common causes of missed periods

The most common causes of missed periods include:

  • Amenorrhea of ​​hypothalamic origin (FHA):
    • FHA caused by overexposure to stress
    • FHA caused by excessive weight loss
    • FHA caused by excessive exercise
  • Pituitary causes:
    • hyperprolactinemia
    • empty saddle team
  • Disorders of the functions of other endocrine glands: e.g. thyroid disorders
  • Multifactorial Disorder: Polycystic Ovary Syndrome (PCOS)
    • Secondary amenorrhea due to medication

How can I get my menstrual cycle back to normal?

The return of menstruation is possible after finding and eliminating the cause that led to the hormonal imbalance and the cessation of menstruation. If it is a disease, appropriate treatment should be given in this direction.

When the cause is too restrictive diet or too intense physical exertion, the lifestyle is corrected.

The element supporting the restoration of hormonal balance is diet and the use of certain herbs or supplements.

Amenorrhea of ​​hypothalamic origin

Hypothalamic amenorrhea occurs in 20-35% of women who experience secondary cessation of menstruation. Disruptions in the hypothalamus disrupt the pulsatile secretion of gonadoliberinresponsible for the reduction of LH and FSH secretion by the pituitary gland.

This in turn leads to decreased estrogen synthesis by the ovaries and ovulation arrest. The factors that lead to disorders of the hypothalamus are primarily:

  • chronic stress,
  • restrictive diet,
  • as well as excessive exercise.

Diagnostics of the loss of menstruation of hypothalamic origin

The diagnosis of hypothalamic amenorrhea includes, first of all, a clinical interview conducted by a doctor who learns about the patient's lifestyle, training intensity, diet, and recent stressful events.

Tests for FHA include: LH and FSH concentration tests and estradiol tests. If they are low, this confirms the hypothalamic cause. This must be accompanied by a decreased gonadotropin response in the GnRH test.

Treatment

Treatment of amenorrhea in FHA resulting from excessive exercise includes exercise reduction and dietary changes. When that doesn't work, the hormones estrogen and progesterone are given to recreate the natural menstrual cycle.

If the cause is weight loss disorders resulting from anorexia or bulimia, psychotherapy is started. The patient must also change her diet, and in the case of malnutrition, increase her caloric value, because the appropriate level of adipose tissue in a woman is necessary to regain a proper menstrual cycle.

Cessation of menstruation due to PCOS

Up to 12% of mature women may suffer from PCOS, and in adolescents it is 1-6%. The cause of this type of disease may be a disturbance in the metabolism and androgen synthesis in the ovary.

There may also be a disruption in insulin secretion or LH production. There are also some genetic tendencies as well as other factors, e.g. late onset of sexual maturation.

PCOS diagnostics

PCOS is diagnosed when menstrual disorders occur, secondary amenorrhea occurs, it is accompanied, for example, by insulin resistance, an increased number of prenatal follicles in the ovaries, and symptoms characteristic of hyperandrogenism, such as: acne, hirsutism, androgenic alopecia.

To conclusively determine if a woman has PCOS, an ultrasound should be performed. If the ultrasound image shows the volume of her ovary above 10 ml, or if she has at least 12 follicles, 2-9 mm in diameter, and has secondary amenorrhea or disturbances in the menstrual cycle and associatedwill also be hyperandrogenism, then it can be considered that she suffers from PCOS.

PCOS treatment

Treatment for polycystic ovary syndrome varies according to symptoms and phenotype. If we are dealing with a hyperandrogenic phenotype, then drugs with an anti-androgenic effect are included.

These are, for example, contraceptives with progestins. If a patient with PCOS has metabolic disorders, is obese or has carbohydrate disorders, then metformin will be started.

It is also recommended to change the diet and reduce body weight if you are overweight. Due to the fact that each case is different, individual therapy is recommended for all symptoms and the entire clinical picture.

Hyperprolactinaemia as the cause of amenorrhea

Hyperprolactinemia is a disorder in which an excess of a hormone called prolactin is secreted at certain times, leading to hormonal imbalance and the cessation of menstruation. Hyperprolactinaemia may be a consequence of an underactive thyroid gland, liver failure, kidney failure, or may be the result of taking certain medications.

Diagnostics of hyperprolactinemia

To confirm the presence of hyperprolactinaemia, a serum PRL test should be performed. If it is elevated, it may be a symptom of this condition. The norm of the PRL does not have to exclude hyperprolactinemia, because everyone has an individual sensitivity to this hormone and their body will react with a disturbance even at normal prolactin levels. So what to do to find out that something is wrong with us? Test with metoclopramide or TRH.

PRL results significantly exceeding the norm, ie above 200-300 µg / l, may indicate the presence of a pituitary adenoma. Its existence is confirmed by imaging: computed tomography or magnetic resonance imaging.

If these tests do not confirm the existence of a tumor, then diagnostics are extended to include other tests, e.g. TSH - by examining the functioning of the thyroid gland, or checking the efficiency of the kidneys or liver.

You can also look for a problem in other organs through imaging tests.

Treatment of hyperprolactinaemia

Drugs used in hyperprolactinaemia are dopamine agonists that stimulate the peripheral metabolism of the PRL. Thanks to this, after prolonged use of drugs, it is possible to reduce the size of the pituitary adenoma.

The most commonly used pharmacological agents during therapy are:

  • bromocriptine,
  • chinagolid,
  • kaberoglina,
  • pergolide,
  • lizuryd.

Drug treatment is appliedmost often, when the tumor is too large to be operated on (then its size is reduced with the help of medications to enable surgery) or when the tumor has not been fully removed after surgery.

Radiotherapy is sometimes used to treat hyperprolactinaemia, but this only happens when it has recurred after surgery or if a large, unresectable tumor is unresponsive to medication.

Empty saddle syndrome as the cause of amenorrhea

Empty saddle syndrome is when the structure surrounding the pituitary gland, known as the saddle, puts pressure on the pituitary gland, causing it to shrink and thus impair its functioning.

The common symptom of this disease is eye pain, headache, while the consequence of pressure is a decrease in the production of gonadotropins and secondary amenorrhea.

Diagnostics of the empty saddle syndrome includes imaging tests such as: magnetic resonance imaging or computed tomography, and the treatment is associated with the use of estrogens and progesterone or, for example, if there is a leakage of the cerebrospinal fluid through the nose, with surgical intervention .

Thyroid disorders and amenorrhea

Both hyperthyroidism and hypothyroidism can lead to menstrual disorders. In hyperthyroidism, due to increased metabolism, and thus the appearance of caloric deficiencies, in hypothyroidism due to concomitant hormonal disorders.

To check if you are suffering from hypothyroidism, you should perform TSH, Ft3, Ft4, anti-TPO and anti-Tg tests.

These last two parameters are necessary to determine if there is autoimmune thyroiditis, or Hashimoto's. An ultrasound of the thyroid gland is also performed to determine its size and whether or not there are nodules.

If hypothyroidism is diagnosed, drugs such as levothyroxine are administered, and in the case of hyperthyroidism, e.g. thyrozole and cardiac drugs, e.g. propranolol.

Diet supporting the restoration of menstruation

Depending on what is behind the amenorrhea, we follow a different type of diet. If the body weight is too low and the amount of adipose tissue is too low, the caloric content of the diet is increased, following the principle that for each kilogram of the body there should be about 40 kcal.

A diet for emaciated people should be highly nutritious, consisting of good-quality protein, unsaturated fatty acids from fatty fish or olive oil, as well as good-quality carbohydrates from groats, e.g. millet, which is easily digestible, and at the same time provides B vitamins or silicon.

When the underlying failureduring menstruation there are hormonal disorders caused by poor thyroid function, e.g. hypothyroidism, hyperthyroidism or Hashimoto's, then you need to focus on providing an adequate supply of protein that the thyroid needs for proper functioning.

In addition, in the case of hyperthyroidism, the caloric content of the diet should be increased, because with this disease the metabolism increases by up to 20-25%. With Hashimoto's, which leads to hypothyroidism, it is necessary to support the liver by providing products rich in B vitamins, as well as being a source of selenium (e.g. Brazil nuts).

The diet should be anti-inflammatory with either Hashimoto's, PCOS or hyperprolactinemia. It can be a Mediterranean diet with lots of fatty fish that will provide you with anti-inflammatory omega-3 fatty acids, olive oil as a source of omega-9 fatty acids, or walnuts with a good ratio of omega-3 to omega-6.

In an anti-inflammatory diet, the ratio of omega-3 to omega-6 fatty acids is very important, because they fight for a place at the same receptors. When omega-6s are predominant, it can increase inflammation.

And this happens often when we fry in rapeseed oil and like to eat various seeds that are the source of omega-6 fatty acids. The best ratio of omega-3 to omega-6 is 1: 4-5.

An anti-inflammatory diet is one that, in addition to unsaturated fatty acids, provides the body with antioxidants. They can fight free radicals that damage cells and disrupt their function.

The most antioxidants are found in purple fruits and vegetables, i.e. blueberries and blueberries. However, it should be emphasized that each fruit color affects a different type of free radicals. So you need to eat a variety of carrots, apricots, or pumpkin rich in beta-carotene; tomatoes having lycopene; avocado or gooseberries, which are the source of lutein.

What supplements to take in the absence of menstruation?

Vitamin D3

Supplementation in the case of menstrual disorders should be selected individually, based on tests that will determine what elements, vitamins or other nutrients we may lack.

However, taking into account that a growing number of people, also he althy ones, have large deficiencies of vitamin D3, it is recommended to use it daily in a dose of at least 2000 units.

This vitamin has an anti-inflammatory effect, and at the same time, as confirmed by research, it has a positive effect on the regulation of the menstrual cycle, follicle maturation, and proper ovulation in people with the syndromepolycystic ovaries.

Tran

Tran is also a welcome supplement if we do not eat fatty fish on a regular basis (i.e. 2-3 times a week). It will provide us with the necessary amount of omega-3 acids and thus have anti-inflammatory properties. It will also have a positive effect on the production of female sex hormones.

Inozytol

Inositol is a B vitamin that, according to the Gynecological Society, can be helpful in the treatment of PCOS because it can reduce the hyperinsulinemia that so many women with polycystic ovary syndrome struggle with.

Inositol supplementation can restore menstruation and ovulatory cycles, improves the regularity of cycles and insulin metabolism, as well as prevents hyperandrogenism.

Niepokalanek monks

The influence of chasteberry on the regulation of the menstrual cycle has been known for centuries. An important aspect of the action of this plant is its ability to reduce the level of prolactin, which is of great importance, for example, hyperprolactinemia. Especially dried chaste fruit have the ability to inhibit the secretion of prolactin stimulated by TRH.

As shown, for example, by the studies conducted in 1993 on a group of 52 women with luteal phase disorders resulting from hyperprolactinemia, after 3 months of using capsules with chicastite monk, the release of prolactin decreased and the luteal phase was shortened.

Reports on the effects of chasteberry not only refer to reducing the level of the PRL, but also indicate that this plant can reduce the symptoms associated with menstrual tension syndrome, and is also helpful in reducing mastalgia (breast pain).

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