Amenorrhea, Acupuncture and Herbal Medicine

By Jiang Liu, Diplomate of Oriental Medicine
AR Licensed Acupuncturist and Herbalist
Acupuncture & Chinese Medicine Clinic
2024 Arkansas Valley Dr., Suite 402
Little Rock, AR 72212

Amenorrhea (loss of menstrual period) is the absence of menstruation or absence of periods. Women normally do not menstruate before puberty, during pregnancy, and after menopause. There are two types of amenorrhea: primary amenorrhea and secondary amenorrhea. Primary amenorrhea is when a young woman has not had her first period by the age of 16. Secondary amenorrhea is when a woman who has had normal menstrual cycles stops getting her monthly period for 3 or more months. Many conditions that cause amenorrhea have other serious complications: for example, polycystic ovary syndrome is associated not only with infertility but also with a higher risk for uterine cancer, heart disease and diabetes; hypothyroidism, another common cause of amenorrhea, carries serious physical and mental risks; amenorrhea associated with reduced estrogen levels increases the risk for osteoporosis (loss of bone density).

Causes
Amenorrhea can be caused by any changes in the organs, glands and hormones involved in menstruation. The most common cause of primary amenorrhea is delayed puberty due to some genetic factor. In many cases, the cause of primary amenorrhea is not known. Common causes of secondary amenorrhea include: pregnancy, breast feeding, stopping the use of birth control, some birth control methods such as Depo-Provera and menopause. Other causes of secondary amenorrhea include:

Stress
Poor nutrition
Depression
Certain drugs
Extreme weight loss
Over-exercising
Ongoing illness
Sudden weight gain or being very overweight (obesity)
Hormonal imbalance due to polycystic ovarian syndrome (PCOS)
Thyroid gland disorders
Tumors on the ovaries or brain

Conventional treatment
Treatment depends on the cause of amenorrhea. Treat the underlying causes such as surgery for hypothalamic and pituitary tumors or anatomical abnormalities of the genital tract. Prescription medications used to treat amenorrhea include birth control pills, medroxyprogesterone, gonadotropin-releasing hormone (GnRH) or gonadotrophin therapy, dopamine agonists or hormone replacement therapy according to underlying causes.

Chinese medicine
Acupuncture improves hormonal imbalances that can be associated with amenorrhea and related conditions, such as polycystic ovary syndrome (PCOS). In a number of preliminary trials1,2,3,4, acupuncture has been shown to induce ovulation in women with disorders involving lack of ovulation. Preliminary studies show that levels of estrogen and progesterone, as well as levels of the related hormones LH (luteinizing hormone) and FSH (follicle-stimulating hormone), may all be affected by acupuncture5,6. One preliminary trial found it helpful for women who have widely separated menstrual cycles7. In controlled trial8,9, amenorrheic women showed a trend toward normalizing hormone levels following acupuncture. Acupuncture could cure some anovulatory patients in a highly effective rate possibly by regulating the dysfunction of Hypophyseal-Pituitary-Ovarian Axis in several ways, including some gene expression of brain, thereby, normalizing secretion of some hormones, such as GnRH, LH and E2.

Etiology and clinical manifestations
In Chinese medicine, the liver, spleen and kidneys are the most important organs that regulate blood and menstruation; and qi and blood are the key fundamental substances. The liver “stores the blood,” and is responsible for maintaining a smooth, even flow of blood and qi. Emotions such as anger, irritation, resentment and anxiety can lead to stagnation of liver qi, which in turn can lead to blood stasis. A main function of the spleen is to produce qi and blood. If the spleen is weak, there will eventually be a deficiency of qi and/or blood, so there will not be enough blood for normal menstruation or enough qi to regulate normal cycles. Also, if the spleen is too weak, it can lead to a condition of dampness in the body, and phlegm-damp can obstruct the uterus. The kidneys are the organ responsible for conception, reproduction and aging over time. Kidney-essence is the ultimate origin of menstrual blood. The following are the common causes of Amenorrhea.
qi and blood deficiency: There is a gradual cessation of menstruation. Typically, periods become shorter and scantier and eventually stop completely. Signs and symptoms include: absence of menstruation, pale complexion, general fatigue and weakness, dizziness, blurred vision, palpitations, bruises easily, headaches, weakness of the limbs, loose stools, palpitations, sleepiness, breathlessness, insomnia, dream-disturbed sleep, dry skin, lusterless hair and brittle nails.
Liver and kidney deficiency: There is a gradual cessation of menstruation. At first, the menses become thin and scanty, then gradually stops completely. Signs and symptoms include: absence of menstruation for a significant period of time, fatigue, soreness and weakness in the loins and legs, lower back pain, dizziness, headaches, tinnitus, anxiety, hot flashes, excessive perspiration, lusterless hair, brittle nails and frequent urination.
qi stagnation: There is an irregular menstrual cycle initially and then the menstruation stops gradually or suddenly. Emotional stress is the most common origin of this pattern. Signs and symptoms include: absence of menstruation, depression, anxiety, a sensation of fullness in the chest and under the rib cage, swelling or fullness of the abdomen with an aversion to pressure, breast tenderness, headaches, lack of appetite and alternating diarrhea/constipation, and frequent sighing.
Blood stasis: There is an irregular menstrual cycle initially and then the menstruation stops gradually or suddenly. Emotional stress or trauma is the most common origin of this pattern. Signs and symptoms associated are the same as the above symptoms of qi stagnation but the pain may be intensified. Other signs and symptoms may include a palpable abdominal mass, purple lips, headaches, sallow complexion and dark skin macules.
Phlegm/dampness obstruction: There is delayed period and then menstruation gradually stops. Being overweight as well as the habitual consumption of cold, raw, or greasy foods (especially dairy products) are most likely the cause of this pattern. Signs and symptoms include: absence of menstruation, obesity, excessive sticky and clear vaginal discharge, nausea, headaches, chest constriction, phlegm in the throat, abdominal bloating, edema, fatigue and general weakness.

Principle of treatment
qi and blood deficiency: Supply qi, nourish blood, regulate menstruation and reduce pain
Liver and kidney deficiency: Tonify kidney, nourish liver and regulate menstruation
qi stagnation: Regulate qi, smooth liver and eliminate stagnation
Blood stasis: activate blood, eliminate stasis and smooth meridian
Phlegm/dampness obstruction: Tonify spleen, remove damp phlegm and expel cold from meridians

References
1. Chen, BY et al, Relationship between blood radioimmunoreactive beta endorphin and hand skin temperature during the electro-acupuncture induction of ovulation. Acupuncture & Elctro-Therapeutics Research The International Journal 16(1), 1-5, 1991
2. Stener-Victorin E, Waldenstrom U, Tagnfors U, et al. Effects of electro-acupuncture on anovulation in women with polycystic ovary syndrome. Acta Obstet Gynecol Scand 2000;79:180–8.
Mo X, Li D, Pu Y, et al. Clinical studies on the mechanism for acupuncture stimulation of ovulation. J Tradit Chin Med 1993;13:115–9.
3. Yu J, Zheng HM, Ping SM. Changes in serum FSH, LH and ovarian follicular growth during electroacupuncture for induction of ovulation. Chung Hsi I Chieh Ho Tsa Chih 1989;9:199–202,195 [in Chinese].
Mo X, Li D, Pu Y, et al. Clinical studies on the mechanism for acupuncture stimulation of ovulation. J Tradit Chin Med 1993;13:115–9.
5. Yu J, Zheng HM, Ping SM. Changes in serum FSH, LH and ovarian follicular growth during electroacupuncture for induction of ovulation. Chung Hsi I Chieh Ho Tsa Chih 1989;9:199–202,195 [in Chinese].
6. Gerhard I, Postneek F. Possibilities of therapy by ear acupuncture in female sterility. Geburtshilfe Frauenheilkd 1988;48:165–71 [in German].
7. Kubista E, Boschitsch E, Spona J. Effect of ear-acupuncture on the LH-concentration in serum in patients with secondary amenorrhea. Wien Med Wochenschr 1981;131:123–6 [in German].
Bo-Ying Chen, Acupuncture Normalizes Dysfunction of Hypothalamic-Pituitary-Ovarian Axis. Acupuncture & Electro-Therapeutics Res., Int. J., Vol. 22, pp. 97-108, 1997