Amenorrhea refers to the absence of menstruation, and more specifically 3 missed cycles in a row.
There are two main types of amenorrhea:
Primary amenorrhea: menstruation never begins at puberty.
Secondary amenorrhea: menstruation starts out normal but then later becomes absent or irregular.
Causes of amenorrhea may include:
- obesity
- low body fat
- thyroid disease
- pituitary gland dysfunction
- chronic stress
- ovarian cysts
- certain medications
Though the hormonal birth control pill is often recommended as a hormonal treatment to address period problems and re-establish regular menstrual cycles, it is not actually triggering a real period and doesn't address the reasons as to why menstrual irregularity is occurring in the first place. Hormonal birth control is also associated with short and long-term health risks.
Fortunately, there are many things that we can do to start to promote a regular menstrual cycle and nutritional supplements that can support this process.
Nutrition
Nutrition is an important part of treating menstrual issues, which includes addressing your eating habits and ensuring that you are meeting your caloric needs. Restricting calories and following excessive food rules is most often detrimental and can promote unhealthy eating patterns not to mention increase stress levels.
Menstrual disorders very often arise from high or chronic stress, dieting as well as an unhealthy relationship with food. This can increase the risk of developing functional hypothalamic amenorrhea. FHA is a diagnosis of exclusion and occurs when the brain isn't getting the proper message to ovulate and menstruate, usually due to high stress or lack of calories. This can come as a result of excess or too intense exercise, caloric restriction, extreme weight loss, and/or psychological stress (1).
Functional hypothalamic amenorrhea is common among female athletes due to a combination of high levels of intermittent or chronic stress, increased energy expenditure, and imbalanced nutrient intake (2)(3).
Females do require enough body fat in order to have a healthy and ovulatory period. When a level of over 30% body fat loss is reached, the risk of menstrual dysfunction rises (4).
A healthy weight is important to maintain as excess weight as well as too little weight is associated with menstrual dysfunction (5).
Emotional health is also an important factor to consider and finding support around your relationship with food and body image is encouraged.
Make sure you're getting enough fats
Healthy fats are involved for the manufacturing of many hormones and are essential for reproductive function. Research shows that dietary fat intake affects menstrual and fertility outcomes in women of reproductive age (6).
Fats are also important to include in order to stabilize blood sugar, a common obstacle in the way of balanced hormones and menstrual issues.
But it's not just any fats! There are many inflammatory sources of fat typically found in processed foods that are detrimental to health.
Examples of healthy fats in the diet include extra virgin olive oil, olives, coconut, coconut oil, avocado, avocado oil, raw nuts and seeds, wild fatty fish, grass-fed meat, free-range eggs, ghee, and grass-fed butter.
Enjoy pineapples and papayas
Fruits are actually hormone-friendly foods that should be included to support female sex hormones and regular menstruation. Fruit is a source of natural sugar for proper endocrine function but also a rich source of antioxidants, needed for egg quality and ovulation. Whole fruit is recommended over fruit juices, which can negatively impact blood sugar.
Pineapple may be particularly beneficial for women's hormones and menstruation because it is a good source of vitamin C and vitamin B6, which are important for healthy hormones!
The enzyme found in pineapple, bromelain, is well known for its anti-inflammatory properties (7). Inflammation is significantly associated with PMS symptoms thus eating anti-inflammatory foods may help to improve hormonal symptoms associated with the menstrual cycle.
Bromelain is found in fresh pineapple and most abundantly in the core of the pineapple. Research suggests that this enzyme may be as effective as NSAIDS in the treatment of pain and inflammation with fewer side effects (8). As most of us would rather not eat the core of the pineapple, bromelain is also available in supplement form.
Papaya is another tropical fruit that may be particularly beneficial to support a healthy cycle. It is rich in vitamins A, B, and E as well as antioxidants and the enzyme, papain.
Papain is a proteolytic enzyme that can help to support digestion, and more particularly the breakdown of protein. This may indirectly support hormones by improving digestive function and nutrient status while reducing inflammation. Papain has been shown to reduce inflammation, pain, and support immune function (9)(10).
Please note, these foods won't necessarily bring on your period however they can be beneficial additions to your whole food diet to support your menstrual experience and cycle.
Common Vitamins and Supplements to Treat amenorrhea
Inositol
Inositol is a popular supplement recommended in the treatment of Polycystic Ovarian Syndrome (PCOS), which is often accompanied by irregular cycles and anovulation.
Inositol has been shown to improve ovulatory function, restore menstrual cycles, and increase fertility outcomes among women with PCOS (11). Inositol can very helpful in the management of PCOS as it has also been shown to reduce androgen levels and insulin resistance, which are characteristic in the condition (12).
Studies confirm that inositol represents a safe and alternative treatment for women with PCOS with no reported side effects (13).
Folate
Folate, also referred to as folic acid, is a well-known vitamin recommended to women during pregnancy as it is vital for the fetus’ development (14).
A study found higher serum concentrations of folate were associated with higher live birth rates compared to women with low levels of folate (15).
Folate may also play a role in menstrual regularity and ovulatory cycles by supporting healthy levels of progesterone and stimulating blood flow (16).
Taking a supplement with folate may help to improve ovarian function, ovulation rates, and pregnancy outcomes (17).
Cinnamon
A warming spice, cinnamon is particularly beneficial for balancing blood sugar levels. Blood sugar stabilization is an essential factor to address when it comes to establishing hormonal balance and regular cycles.
Cinnamon is said to support increased serum progesterone levels during the luteal phase, facilitating menstrual cycle regulation (18).
As a warming spice, it can help to increase circulation to the pelvis area, ease PMS, and reduce excessive menstrual bleeding.
A study among women with Polycystic Ovarian Syndrome found that cinnamon supplementation during a 6 month period improved menstrual cyclicity (19).
Cinnamon is regarded as a safe and effective treatment for primary dysmenorrhea, shown to reduce symptoms associated with the menstrual cycle such as pain, menstrual bleeding, nausea, and vomiting (20).
Cinnamon is also used to treat insulin resistance and lower high insulin and blood glucose levels (21)(22).
These benefits may all help to improve hormonal balance and menstrual cyclicity among women of reproductive age.
You can add cinnamon to your food as nutritional support however cinnamon supplementation will likely be more effective to receive its therapeutic effects.
Turmeric
Curcumin, the active constituent found in the herb and spice turmeric, can provide many beneficial effects for improving symptoms associated with menstruation but also menstrual regularity and ovulation.
It is actually a mild phytoestrogen, meaning it contains estrogenic properties (23).
Curcumin has traditionally been used as an emmenagogue herb that stimulates blood flow in the pelvic area and can even help to bring on menses (24). Its beneficial effects on the menstrual cycle may be attributed to its anti-inflammatory properties but also its liver cleansing, digestive supporting, blood purifying, and uterine stimulating effects.
A study assessing curcumin's potential for treating PCOS showed improved ovulation and corpus luteum, suggesting it may be beneficial in supporting healthy ovarian function (25).
Due to its potential uterine stimulating effects, supplementation is not advised during pregnancy.
Evening primrose oil
Evening Primrose Oil is an omega-6-fatty acid and is often used to treat premenstrual syndrome and menopausal-related symptoms (26).
Getting enough essential fatty acids, including omega 6 fats, supports overall hormonal function. EPO may also help to balance estrogen levels and maintain a healthy estrogen to progesterone ratio, an important factor for regular menstruation and ovulation.
This oil contains large amounts of gamma-linolenic acid (GLA), an omega 6 fat that may help to regulate prostaglandin production, reducing inflammation and oxidative stress and supporting overall hormonal balance.
It's important to balance the omega 6 fats with sufficient omega 3 fat intake in order to keep healthy ratios in check, regulate inflammation in the body, and support overall health (27).
Castor oil
We need to have good liver function in order to achieve hormonal balance. The liver processes all of our hormones and will detoxify excess hormones from the body. If the liver isn't able to do this optimally, it is common for estrogen to build up in excess which can lead to a relative progesterone deficiency. Castor oil is an effective herbal and natural treatment to support liver detoxification and the processing of excess hormones.
Castor oil packs are applied topically to the lower abdominal area to support hormonal balance, liver health, and digestive function. It contains a variety of beneficial nutrients such as fatty acids, amino acids and antioxidants (28).
Traditionally referred to as an emmenagogue, castor oil can stimulate menstruation in cases of delayed menses (29)(30)
It has also been shown to be effective at reducing the occurrence of fibroids and cysts as well as pain and inflammation associated with menstrual disorders (31).
Castor oil does have labor-inducing effects thus it is not recommended during pregnancy (32)(33).
Black cohosh
Black cohosh is a particularly well-known herb for treating unwanted menopausal symptoms. But can it help the menstrual cycle?
Black cohosh has a history of being used traditionally for various hormonal disorders, including amenorrhea and infertility (34). This herb contains estrogenic compounds which can help to stimulate female fertility hormones such as estrogen, progesterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH). It can potentially help to restore missing periods by reinitiating uterine contractions, thickening the endometrial lining, and improving progesterone levels.
Research among women with PCOS suggests black cohosh may be a useful treatment in restoring ovulatory function (35).
Chaste berry
Also known as vitex agnus-castus, chaste berry is one of the most well-known and popular herbs used to restore ovulatory and regular cycles. It is also often used to treat PMS, reducing symptoms such as irritability, fluid retention, and breast pain (36).
Chaste berry can help to improve menstrual cyclicity by reducing prolactin levels, raising progesterone, and regulating estrogen levels (37).
This herb typically takes up to 3-4 months to notice a significant effect or changes.
Though vitex can be very effective for many women, in certain cases it may cause adverse effects. This may also be related to the dosing of the herb and when it is used during the cycle. Verify with your health care provider first before supplementing for the first time.
Mugwort
Another herb that can help treat menstrual issues, mugwort is classified as both an emmenagogue and a uterine tonic (38). As a warming herb that supports blood circulation in the pelvic area, mugwort can help to restore absent menses, reduce discomfort, and encourage smooth blood flow during menstruation.
This herb has muscle-relaxing effects and its antispasmodic actions can help to reduce pain and cramping in the uterus as well as excessive menstrual bleeding (39).
Mugwort can be consumed as a tea or in supplement form. Avoid using it during pregnancy due to its uterine stimulating effects.