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Amenorrhoea is the absence of menstruation i.e., either a lack of onset or the cessation of normal menstruation.

Absence of menstruation may occur for a variety of reasons. It is very important for any woman who has stopped menstruating to consult a medical practitioner immediately for diagnosis.

Physiological Amenorrhoea
Pregnancy and menopause are two very natural reasons for menstruation to cease, known as physiologic Amenorrhoea. In other words, there is an obvious physical reason for the lack of menstruation, which does not involve a disease process. The late onset of menstruation is often a cause of concern for young girls and their parents. Providing, however, puberty has progressed normally, the girl is of normal weight and there are no other abnormal physical signs, there is usually no cause for concern in girls under 16 years of age. A Doctor can conduct a number of tests to check for abnormalities.

Primary Amenorrhoea
Amenorrhoea that is caused by a disease process or changes in hormonal function is classified as either 'primary' or 'secondary' Amenorrhoea. Primary Amenorrhoea is usually diagnosed if a woman has not started menstruation by 16 years of age. This type of Amenorrhoea is usually the result of one of the following conditions; a disorder of the pituitary and/or hypothalamus glands, a chromosomal abnormality (e.g., Turner's syndrome or testicular feminisation syndrome) or abnormal development of the ovaries or uterus.

Secondary Amenorrhoea
This is a relatively common problem and is seen far more often than cases of primary Amenorrhoea. Secondary Amenorrhoea is diagnosed when a woman who is not pregnant and who has been menstruating normally, skips one or more periods. Unlike primary Amenorrhoea, there is usually no disease or medical condition responsible. Secondary Amenorrhoea is more likely to be the result of stress, rigorous athletic training or an extreme change in bodyweight (as is seen in anorexia nervosa). Weight-related and exercise-related Amenorrhoea is common among female athletes, and, if prolonged, is associated with an increased risk of oestrogen deficiency and osteoporosis.

Polycystic Ovary Syndrome
Cysts commonly develop on the ovaries prior to puberty. These are harmless and usually disappear with the onset of menstruation. A hormonal imbalance in some women, however, causes these cysts to continue developing. This abnormal condition is known as polycystic ovary syndrome (POS). Amenorrhoea (both primary and secondary) is a symptom of POS. Other symptoms include lack of ovulation and infertility, acne and excessive body hair. The lack of ovulation caused by POS along with continuous oestrogen production can increase a woman's risk of developing endometrial cancer. Considering this and the number of possible causes of Amenorrhoea it is important for a woman who has not begun to menstruate, or whose normal pattern of menstruation has ceased, to be medically diagnosed and treated.

Always consult your Doctor for diagnosis and advice. In no way is this information intended to replace the advice of a medical practitioner.
Treatment for Amenorrhoea includes hormone replacement therapy, minor surgical procedures and counselling. Treatment depends on the cause and some women will not require treatment at all. As Athletic activity and weight fluctuations can cause Amenorrhoea, your Doctor may refer you to a Dietician who can devise an eating plan for you. Your Doctor will explain the causes of Amenorrhoea and answer any queries that you may have regarding this condition and its treatment.

Amenorrhoea often signals a physical problem, which must be dealt with first. However, a number of nutrients are required for a regular hormonal cycle. Extreme diet fads can induce Amenorrhoea. Some dietary suggestions include:
• Foods high in vitamin B (particularly B12, folic acid and B6) may help the production of hormones. These include brewers' yeast, fruits, vegetables, nuts, whole grains, legumes (beans, peas, lentils etc), seeds and avocados.
• Wheat germ, oats and muesli may help ensure a regular cycle.
• Iron rich foods may help a short or light menstrual cycle. Sources include oysters, spinach, liver, almonds, hazelnuts, prune juice, pecans, parsley juice and eggs.
• Iodine-rich foods may help regulate an irregular menstrual cycle due to thyroid dysfunction. Sources include kelp and other sea vegetables.
• Soybean products, such as tofu and soy milk, may help an irregular menstrual cycle.
• Essential fatty acids, derived from fish, avocados and linseeds (flaxseed), may help regulate hormones.

• Dong quai (Angelica sinensis) may help regulate female hormones.
• False unicorn root (Chamaelirium luteum) may be of benefit for Amenorrhoea as a uterine and ovarian tonic. It may help to regulate and normalise ovarian function.
• Yarrow (Achillea millefolium) may be beneficial in the management of Amenorrhoea.
•Vitex agnus-castus may help to initiate menstruation in some types of Amenorrhoea.
•Pulsatilla (Anemone pulsatilla) and Bupleurum may be useful for Amenorrhoea that is a result of nervousness or stress.
• Female athletes with exercise-induced Amenorrhoea may be on diets that limit iron absorption and may be at risk of iron deficiency.

Ask your MedAux Pharmacist for advice.
1. If you have skipped a period it is important (if applicable) to consider the possibility of pregnancy. Ask for advice about the different home pregnancy tests available from your Pharmacy or see your Doctor.
2. If you are gaining or losing a great deal of weight, ask your Pharmacist for advice about safe and effective ways to maintain your ideal weight. Your Doctor may refer you to a Dietician.
3. If your Doctor has diagnosed stress as being the cause of Amenorrhoea it is important to practise relaxation techniques. Avoiding stressful situations and people, having adequate exercise, rest, and a healthy diet and doing enjoyable activities all have a role in stress and anxiety management.

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