April 28, 2020
Amenorrhea (the absence of periods over three months or longer) is a complex condition with several possible underlying causes. General lifestyle, nutrition, exercise and daily stress levels all play their important part in a woman's balanced and regular monthly cycle.
In Chinese medicine, amenorrhea can be caused either by deficiency or obstruction/stagnation.
Deficiency types include amenorrhea due to Kidney Jing deficiency, Kidney Yin deficiency and Blood deficiency:
Kidney Jing (Essence) forms our main energy reservoir, initially inherited from our parents and used up throughout our life. It is the foundation of our life force, so if the Essence is very weak it can be a cause for both primary (periods never started) and secondary (periods stop over time) amenorrhea. In TCM the Kidneys are responsible for our bone health. With Jing weakness, the production of Blood from marrow is lacking, so there is not enough Blood and menstruation stops.
Kidney Yin deficiency is the most common cause of amenorrhea. The Yin, cooling and nourishing element, can become deficient due to lifestyle factors or a person’s constitution. Yin is required for the eggs to ripen, for the production of fertile cervical mucus and to aid making Blood in order to thicken and nourish the endometrium. Deficient Kidney Yin symptoms include infrequent or no periods, no fertile cervical mucus (egg white consistency around ovulation), dizziness and dull lower back pain.
Blood deficiency amenorrhea is usually associated with Kidney Yin weakness. In some cases, amenorrhea follows loss of large amounts of blood after hemorrhage (such as termination of pregnancy, miscarriage or childbirth) or is a result of a reduced Spleen function, which supports Blood production in TCM. The Spleen can be weakened by excessive physical strain, e.g. young women training intensively in sport, long phases of overwork and/or under-nutrition, or after long-term illness. Here, treatment focuses on diet, with an emphasis on iron-rich and other blood-nourishing foods. A good balance between rest and exertion is also important.
Amenorrhea from obstruction is a result of stagnation of Heart or Liver Qi, Phlegm-Damp accumulation or Blood stasis. Periods that cease due to blockages tend to stop quite suddenly, compared with periods which stop because of deficiency. In deficiency, the periods may become irregular, infrequent or scanty before stopping. TMC treatment of obstruction can bring fast results if the stagnation is not too long term and has not created other imbalances.
Heart Qi becomes stagnant if there is prolonged mental stress or anxiety. Qi Gong, yoga, meditation or stress-reducing techniques are an important adjunct to the treatment. If the Heart stagnation has not caused damage to the Kidney Yin and Yang, then resolution of the stagnation will be enough to re-establish a regular menstrual cycle.
Liver Qi can become stagnant and lead to amenorrhea if there is prolonged frustration, irritability or depression. High levels of stress or life changes, such as moving countries or a lot of traveling, can cause periods to disappear. This type of amenorrhea can also occur after long-term breast-feeding (more than one year).
Post-pill amenorrhea is the failure of a menstrual cycle to return within six months of discontinuing the oral contraceptive pill. The pill interrupts natural body cycles, so the Liver Qi (responsible for regular body rhythms) is affected. In some women, this effect lasts after the pill has been stopped, so the cycles do not easily re-establish themselves.
Phlegm-Damp accumulation amenorrhea can arise through poor eating habits, especially of rich, greasy and sweet foods, or from an inherited weakness of internal organs or disruption in their function by Qi or Blood stagnation. Amenorrhea associated with weight gain is always indicative of Phlegm-Damp accumulation.
Blood stasis amenorrhea related to tumours in the ovaries or other glands is not common. This can be caused by repeated D&Cs, which form adhesions affecting the lining of the uterus and block menstrual flow. Surgery may be required to remove these obstructions, but Chinese herbs can be helpful in recovering the integrity of the endometrium.
Amenorrhea is a complex condition, so usually the combined treatment with acupuncture, Chinese herbs, nutritional and exercise programme needs to be followed for at least three months.
Appropriate TCM treatments:
Acupuncture - ✅
Chinese herbs - ✅
Dietary/Lifestyle advice - ✅
Moxa/Heat lamp - ✅
Qi Gong - ✅
Tuina (meridian massage)