Absence Of  Menses

Absence of  menses can be quiet frustrating, specially for the women who is trying to get pregnant.

Having a healthy and regular cycle  is the first step towards trying to get pregnant.

There are many reasons that the cycle can be irregular or absent.

Absent period is known as Amenorrhea in medical terms, lets look in to the types and the causes of Amenorrhea

1.Primary Amenorrhea

2.Secondary Amenorrhea

 Primary Amenorrhea –

 Absence of menses with or without the development of secondary sexual characteristics  by the age of 16 it is termed as primary amenorrhea.

Secondary amenorrhea

Defined as the absence of menstruation for the total of at least 3 previous menstrual cycle lengths, or at least 6 months in a woman who previously had a menstrual cycle and is still in her reproductive years.

Causes of Absent Period

It is very important to note that  amenorrhea is not a disease. It is a sign that  there is an underlying imbalance in the body.

A regular menstrual cycle is regulated by a well orchestrated  mechanism between the pitutary, hypothlamus and ovaries.

Each gland responding to the messages received by the other by releasing an hormone, any miscommunication can cause this loop to get disrupted and end in malfunction thereby affecting the cycle.

What could be the causes of this miscommunication?

Nutritional Deficiencies- Sometimes the body does not get enough nutrition  to sustain normal function and nutritional deficiency can cause menstrual irregularities.

So what and how much you eat is very important.

 lets look at  the key nutrients that support a healthy  menstrual cycle.

Iron:  iron deficiency causes  lack of ovulation, poor egg health 

Vitamin C: Vitamin C improves hormone levels and increases fertility in women. 

B Vitamins: is  necessary for proper hormonal balance. 

Essential fatty acids: EFA’s are important for hormone production.  Deficiency of omega 3 is  an important factor  for hormonal imbalance.

Cholesterol: Cholesterol is necessary for hormone production. Avoid eating a ‘low-fat’ diet.  Best option is cold pressed coconut oil.

Fibre: Fibre helps to remove excess hormones from the body which may be causing hormonal imbalance. Fibre also helps to regulate the blood sugar levels which helps to reduce menstrual issues  and promotes hormonal balance.  So eating those fruits and vegetables is very important.

Zinc:  is very important as it keeps the hormonal levels stable during the entire menstrual cycle. The best source of zinc is pumpkin seeds and sesame seeds  

Being Overweight or Underweight

There is a direct link between the body fat cells and oestrogen

Obese women have too much of oestrogen as they have too much of fat cells. Women who are under weigh will have problems in ovulation  due to lack of fat cells. Too much or too little  of oestrogen leads to disruption of the menstrual cycle .

PCOS

Polycystic ovarian syndrome, is the most common cause of endocrine dysfunction in women of reproductive age.

The two most important features of PCOS are  absent period or irregular cycle and hyperandrogenism  (the body is producing too many androgens, the most common one being testosterone).

Stress

Stress  causes release of cortisol and adrenalin that prevent the other hormones from being released at the right time  thus  disrupting the menstrual cycle.

Secondly it can also have an adverse effect on the thyroid   glands. And impact thyroid health.

Thyroid issues

Poor thyroid function may cause the menstrual cycle to stop.

 An overactive thyroid that produces too many thyroid hormones is called Hyperthyroidism.

Hypothyroidism is when the thyroid is underactive and does not produce enough thyroid hormones.

In both cases it is possible that one  may experience heavy or absent periods.

Pituitary tumour

At times a women can have a  pituitary tumour may cause disruption in the release and manufacturing of certain hormones which may cause the menstrual cycle to stop.

Premature Ovarian Failure

POF, also known as Ovarian Hypo function, is defined as a loss of normal ovarian function before the age of 40. The menstrual cycle may cease before the age of 40, or become sporadic. There are a variety of reasons this may happen.

When should you see a doctor?

If you have not had a menstrual period for 3 consecutive cycles or more,  you should see a doctor

An allopathic practitioner may often prescribe oral contraceptives  but this will only force your body to have a cycle, it will not solve the problem  totally .

An holistic approach including Nutrition, lifestyle management, exercise  and homoeopathy is required to balance your hormones and regulate your cycle.

Polycystic Ovarian Syndrome  is one of the  most complex female health issues of our time.

 It is  also the most common endocrine disorder in women of reproductive age.

PCOS  can be accompanied by variety of  health issues, and can directly impact infertility.

Classically PCOS  presents with irregular menses, abnormal hair growth , weight gain etc,  but not all women diagnosed with PCOS will have all these symptoms .

 

In this article we will discuss  what are the causes,symptoms,and health risks of PCOS.

We will look in to the medical treatmens,natural options, exercise and what dietary changes need to be done.

 

What Causes PCOS?

 

The exact cause is not known  and some say that genetic predisposition is one of the main causes  so if a women’s mother or sister has PCOS she has a risk or getting it too.

Another cause attributed to cause PCOS is the amount of hormonal treatments that the women’s mother has taken to conceive.

PCOS is certainly affected by diet and lifestyle changes

Exposure to certain environmental toxins is also considered an contributing factor.

 

Insulin Resistance

Insulin is a hormone produced in the pancreas and is responsible for converting glucose  in to energy, it also plays an important role in carbohydrate and lipid metabolism.

Insulin resistance happens when the body’s cells become resistant to the effects of insulin.

When this happens, higher levels of insulin are needed so that insulin can have the proper effects.

This makes the pancreas to  work harder and harder to produce more  insulin.

Insulin  also signals the ovaries to secrete testosterone and on the other hand inhibit hepatic sex-hormone binding globulin (SHBG) production which leads to an increased level of circulating testosterone.

 (This is why many women with PCOS experience male pattern baldness, facial hair )

 Excess insulin in the bloodstream also signals the ovaries to release more estrogen which can suppress ovulation.( a reason for unovulatry cycles)

 

Low-grade Inflammation

 

When we get infected by  to bacteria or  virus  our blood cells produce substances to fight this infection this is known as low inflammatory response

Low grade inflammation  can cause insulin resistance and atherosclerosis.

Low grade  inflammation can also be triggered by  certain food products like refined sugar and processed food.

 

 Signs and Symptoms of PCOS

• Irregular menstrual cycles
• Absent period
• Anovulatory cycles
• Abnormal mid-cycle bleeding
• Excessive or heavy menstrual bleeding
• Alopecia (balding)
• Hirsutism (excessive body hair)
• Acne
• Acanthosis nigricans – a darkening of the skin in the armpits, back of the neck, or groin
• Polycystic ovaries
• History of ovarian cysts
• Mood disorders
• Obesity
• Recurrent Miscarriage

Health and Fertility Risks Associated with PCOS

• Infertility
• Menstrual cycle irregularities
• Possible increased risk for endometrial and breast cancer due to unopposed estrogen
• Cardiovascular disease
• Diabetes
• Gestational diabetes

 

How is PCOS Diagnosed?

 

 The first time PCOS was diagnosed  because of the presence of ovaries seen by ultrasound.

Over a period of time doctors have realised that PCOS is not just about ovaries and it is a complex health issue.

This led to certain criteria that must be recognized to be diagnosed with PCOS, rather than just the presence of polycystic ovaries.

 In fact it is seen that some women have many symptoms of PCOS but their ovaries are normal.

 

  Investigations  recommended.

 

Pituitary and Ovarian Hormone serum levels:

 

• Luteinizing Hormone (LH)
• Follicle Stimulating Hormone (FSH)
• Estradiol
• Progesterone
• Prolactin

 

Circulating Androgens:

• Free testosterone
• Free androgen index (FAI): 17-hydroxyprogesterone
• Sex hormone binding globulin (SHBG): 24 hr. urinary free cortisol
• Dehydroepiandrosterone sulfate (DHEA-S)

 

Endometrial Biopsy

Glucose Tolerance Test

Thyroid Panel

Blood Lipid Profile

 

Now let’s see how PCOS affects the Menstrual cycle.

 

IN a normal menstrual cycle

 

 The hypothalamus produces GnRH (gonadotrophin-releasing hormone) which signals to the pituitary to produce LH (luteinising hormone) and FSH (follicle stimulating hormone).

The release of GnRH i signals some of the follicles in the ovary to begin maturing and for the ovaries to release estrogen and progesterone.

This estrogen/progesterone signal is recognized by the pituitary gland and that inturn signals the maturing follicles to increase the oestrigen levels.

In turn the  rising estrogen level signals the pituitary gland to curb the release of FSH.

This communication allows for ovulation to occur.

 

In women with PCOS the menstrual cycle follows a different pattern of endocrine function and communication.

 

 Firstly in women with PCOS the cycle is irregular, with the hypothalamus releasing GnRH in a higher than normal.

 

This allows for increased LH and decreased FSH, which in turn leads to excessive production of the androgens androstenedione and testosterone.

 

This causes the follicle to only mature some, but not enough to achieve full maturity in order to be released for ovulation.

 

This also allows for continued increase of estrogen,

( typically during the reproductive age  oestrogen levels are low)

 

 The higher levels of androgens and estrogen create a chronic state of low to very low progesterone and anovulatory cycles.

 

 Excessive levels of estrogen may also cause uterine hypertrophy, also known as endometrial hyperplasia.

 Endometrial hyperplasia may cause heavy menstrual bleeding or prolonged bleeding during menstruation.

 The uterus may become bulky and larger than normal.

 

When a patient comes to us she may have a combination of  Anovulatory cycles, insulin resistance, and endometrial hyperplasia.

 

Medical management of  PCOS

 

 when Anovulatory Cycles are seen

 

Oral Contraceptive Pills (birth control)  are the  most prescribed medication to regulate menstruation.

This helps  to regulate the cycle but does not solve the root cause of the problem and may actually cause longterm reproductive health problems.

Ovarian drilling done with the intention to stimulate ovulation specially in women who are trying to conceive. 

 

  For Insulin Resistance

Metformin  –  is the drug of choice  even if they are not insulin resistant or have any signs of type 2 diabetes. Metformin helps to control the amount of glucose in the blood.

Metformin comes with risks and side effects, Long-term  use of Metformin has been shown to cause malabsorption of vitamin B₁₂ in some patients. 

 

Management  of PCOS

Important considerations

• It takes at least 6-12 months of consistent lifestyle and diet changes, along with natural therapies to bring about real change in the body when living with PCOS.
• In addition to making changes in the diet, supplements have shown to be effective.
• The overall goal with PCOS is to balance blood sugar levels, maintain hormonal balance, promote healthy digestion for improved estrogen metabolism,while also working to promote regular ovulation and menses.
• Changes in diet should include  consumption of adaptogens , adaptogens are known to reduce the oxidative stress and help to normalize body functions.Adaptogen herbs are also important, this is because adaptogens increase resistance to mind-body stress and enhance overall vitality and health through non-specific adrenal (known as stress glands) support. Plants recognized as adaptogens help to normalize the body’s functions, most importantly the endocrine system, even during diseased states, are non-toxic, nutritive, and have been deemed safe for long term use.

 

Medicines  and supplements are not meant to be a substitute for dietary and lifestyle changes! If diet and lifestyles changes specific to PCOS are not  followed ,  it is difficult to reverse the changes.

 

Holistic approach

 

As we have already seen PCOS is a result of multiple factors  and addressing only one issue and prescribing for it is not going to help we need to go to the root cause. 

 What we need is an holistic approach.

A holistic approach  is an integrated approach to health care that treats the “whole” person, not simply symptoms and disease.

Mind and body are integrated and inseparable.  What ever one feels at an mental emotional level, the food you eat the amount of physical work out you do  all this has a huge impact on the wellbeing of an individual.

 An holistic program consists of nutritional correction, lifestyle changes and homoeopathic medicines.

 

 

 

Supplements That Are Beneficial for PCOS…

 Chromium

This trace mineral enhances the action of insulin. 

Foods that are high in chromium are onions, tomatoes, whole grains, and bran. 

Calcium and Vitamin D

 calcium protects the cardiovascular health, and prevents osteoporosis and vitamin D play significant roles in glucose metabolism. 

Good food sources of vitamin D are cod liver oil, eggs, salmon,.

Vitamin D can also be obtained for free by sitting out in the sun for 15 to 20 minutes per day

 Cod Liver Oil

 Cod liver oil is a rich source of omega3

 omega-3  helps to lose weight, balance hormones, and creates a healthy environment for conception.

   Cinnamon

 reduces insulin resistance  by slowing the movement of the food from the stomach to the small intestine.

 Gymnema (Gymnema sylvestre)

 

This herb has sugar blocking action  on the taste buds and small intestines.hence it blocks the typical paths that sugar molecules take during digestion, delaying the absorption of sugar.

 

 Diet considerations in PCOS

1. Eat Organic

 Non organic food  can contain lot of preservatives and hormones , when you have PCOS it is best to switch to organic food .

2. Balance your daily protein and carbohydrate intake

 

Taking equal amount of  carbohydrate and protiens  helps you to balance your insulin levels 

 Chose whole grain  or sprouted carbs.

Avoid processed carbs  like white flour, potato and bakery products  as they are low  nutritive value &  fibre  and cause a spike in insulin levels.

 It is best to eat locally grown and locally available food.

3. Choose food with low glycemic index.

 

 your blood sugar level rises when you eat carbs, and how long it will remain high will depend on the kind of carbs  that you eat.

Low glycemic index foods are carbohydrates that break down slowly in the body, and don’t cause such a dramatic spike and then drop in insulin levels. 

Some examples of low glycemic index foods are:

• broccoli, asparagus
• Beans and lentils
• Grapefruit and apples
• Walnuts and almonds

 

 

Some examples of high glycemic index foods –

 potatoes, jams, scones, white bread products, pasta, soda, alcoholic beverages,pancakes, syrups, sugar.  It is best to avoid them .

4. Eat a diet high in fiber

Fibre  slows down the digestion  of sugars ( so lesser spikes inn insulin levels)

Fibre helps in promoting healthy oestrogen balance hence reduces the level of androgens.

5. Eat essential fatty acids daily

Eating essential fatty acids (EFA’s) helps you to lose weight, aids hormonal balance, and are important building blocks for the body to create a healthy environment for conception.

The best source of omega 3 is codliver and evening primrose oil.

6. Quit Coffee

Caffeine increases estrogen levels.

 Women who drink 4-5 cups of coffee a day produce 70% more estrogen in the follicular phase of the menstrual cycle 

 

7. Exercise for 45 minutes, 5 days a week

 

Adequate exercise is must to improve insulin sensitivity Exercise helps PCOS by improving insulin sensitivity, increasing metabolism and helping to shed any excess weight.

Both aerobic and resistance exercises are required . 

Avoid excessive exercise programs because too much exercise overworks the adrenal glands which increases inflammation and in turn makes PCOS worse.

Restorative exercise programs are best. You could walk and lift weights, or take a Pilates class and run on the treadmill, or do some Zumba and then Fertility Yoga.

 One day of complete rest is also essential for the body to recover.

 

 

 

 Summary

PCOS is a complex female health issue. It consists of many different health concerns and risks.

 If permanent diet and lifestyle changes are implemented, these risks and health issues can be reversed.

There are many ways to support the proper health of a woman’s body that is dealing with PCOS. Important key tips…

 Follow a PCOS specific diet to help decrease insulin resistance, balance weight, and improve estrogen metabolism.

 Promote hormonal balance and support regular ovulation through supportive  Nutrition , yoga and homoeopathy.

 Stick to your plan, believe in yourself, only you have the ability to change your circumstances!

 

Dr Abhay Talwalkar 

M.D.(HOM)