Amenorrhea is the absence of menstruation (loss of period) in women of reproductive age. It is classified as primary (when a person has not begun menstruating by age 15 or 16) or secondary (when menstruation stops for three or more months in someone who previously had regular periods). Common causes of amenorrhea include hormonal imbalances (such as polycystic ovary syndrome, thyroid disorders, or elevated prolactin levels), and structural issues (such as uterine scarring or congenital anomalies). Lifestyle factors like excessive exercise, low body weight, or stress can also contribute to amenorrhea. Intense physical activity, often seen in athletes, and low body fat percentage can disrupt hormonal balance, particularly the hypothalamic-pituitary-gonadal (HPG) axis. This is known as hypothalamic amenorrhea, and it’s especially common in women with low BMI or who engage in extreme exercise routines. Chronic stress can also impact menstrual cycles by disrupting the HPG axis and leading to hypothalamic amenorrhea.
Women experiencing amenorrhea are encouraged to consult a healthcare provider, as amenorrhea can sometimes signal broader health concerns, including risks for bone density issues if left untreated long-term. Treatment approaches are generally tailored to the underlying cause and may involve lifestyle modifications, hormonal therapy, or counselling support for psychological factors related to stress or eating disorders.
In Traditional Chinese Medicine (TCM), amenorrhea, or the absence of menstruation, is seen as a sign of deeper imbalances affecting Qi, Blood, and the connections between key organ systems—particularly the Heart, Liver, Kidney, and Uterus. TCM approaches amenorrhea by viewing the menstrual cycle as a reflection of the body’s overall health, which includes emotional and psychological well-being. The menstrual cycle is seen as one of the Three Treasures in TCM, this shows the importance of establishing a healthy cycle for overall health, you can read about this here – What are the Three Treasures? This holistic perspective acknowledges that the Heart, Uterus, and emotional health are intimately connected through pathways like the Bao Mai (Uterus Vessel), a critical channel linking the Heart and Uterus.
Key TCM Patterns and Their Impact on Amenorrhea
Heart-Uterus Connection (Bao Mai): In TCM, the Heart governs emotions and houses the Shen, or spirit, while the Uterus is responsible for menstruation and reproductive health. The Bao Mai, or Uterus Vessel, is the channel that connects these two organs. When there is harmony between the Heart and Uterus, Qi and Blood can flow smoothly through the Bao Mai, ensuring regular menstrual cycles. However, stress, unresolved emotions, or trauma can create blockages in the Bao Mai, disrupting this connection and leading to amenorrhea. This blockage is a prime example of how emotional and psychological factors can have a direct impact on reproductive health.
Qi and Blood Deficiency: When Qi (vital energy) and Blood are deficient, the Heart cannot adequately nourish the Uterus, leading to menstrual irregularities like amenorrhea. Common causes include overwork, poor diet, or chronic illness, which deplete the body’s resources. Women experiencing this pattern often show symptoms of fatigue, pale complexion, and low energy. The Bao Mai channel becomes undernourished, leading to menstrual irregularity and further disconnecting the Heart and Uterus.
Qi and Blood Stagnation: Emotional stress and unresolved tension are often stored in the Liver, which plays a crucial role in ensuring the smooth flow of Qi throughout the body. Liver Qi stagnation can obstruct the Heart-Uterus connection via the Bao Mai, leading to symptoms such as mood swings, irritability, and the absence of menstruation. This stagnation highlights how stress and emotional disharmony can create blockages that physically manifest as reproductive issues.
I haven’t had a period in over 3 months, what should I do?
Rule Out Pregnancy: Take a pregnancy test if there’s a possibility you could be pregnant. Pregnancy is a common reason for missed periods, even if other symptoms aren’t present.
Consult a Healthcare Provider: They may assess for conditions such as polycystic ovary syndrome (PCOS), thyroid issues, stress-related hypothalamic amenorrhea, or other hormonal imbalances.
Lifestyle Factors: High stress, excessive exercise, and changes in weight can disrupt the menstrual cycle. If these factors are relevant, adjusting your routine and seeking support for stress management may help.
Tracking and Tests: I recommend tracking symptoms or cycle changes, this could be any changes in cervical mucus which can indicate ovulation is near. You can read about the signs of Ovulation here – How do I know when I am Ovulation?. I also recommend doing further investigations with a full blood count, and a trans-vaginal ultrasound can also be helpful for diagnosing issues such as ovarian cysts or other structural factors.
Find an Multidisciplinary Team: We know working in a shared care team creates better outcomes for the patient. Finding a multidisciplinary team that you feel comfortable with and who are confident in treating Women’s Health.
TCM Treatment Approaches for Amenorrhea
TCM addresses amenorrhea by restoring balance and promoting the smooth flow of Qi and Blood between the Heart, Uterus, and other relevant organs. This is done through a combination of acupuncture, herbal medicine, and lifestyle adjustments.
Acupuncture: Acupuncture is used to target points along the Heart, Liver, and Uterus meridians to regulate Qi and Blood, relieve emotional blockages, and support a strong Heart-Uterus connection. When supporting a female body, hormones produced by the hypothalamus, pituitary, and ovaries play a vital role in whole-body regulation. Acupuncture uses specific points on the body to regulate the Hypothalamic-Pituitary-Adrenal (HPA) & Hypothalamic-Pituitary-Ovarian (HPO) axis, allowing the brain to effectively communicate with the Ovaries and encourage Ovulation which is the most important part of establishing a menstrual cycle.
Chinese Herbal Medicine: Herbal formulas are tailored to address individual patterns such as Blood deficiency, Qi deficiency, and Liver Qi stagnation. For instance, calming the Shen, moving stagnant Qi, and nourishing Blood can all support a balanced Bao Mai, helping to encourage a healthy flow of Qi and Blood to the Uterus.
Lifestyle and Dietary Adjustments: TCM also emphasises the role of stress management, proper nutrition, and rest. Practices such as meditation and mindfulness exercises help reduce emotional tension, calming the Heart and preventing Liver Qi stagnation. Diets rich in nourishing foods, like warm, cooked greens, whole grains, and root vegetables, are recommended to support Blood and Qi and encourage healthy menstrual function.
Amenorrhea can result from various factors, including hormonal imbalances, stress, or lifestyle habits. To effectively address this condition, it’s important to consider both physical and emotional factors.Traditional Chinese Medicine (TCM) focuses on restoring balance to the body’s Qi and Blood, using methods like Acupuncture and herbal treatments to address underlying blockages and nourish the reproductive system. By combining both approaches, women can address the full spectrum of causes, restore menstrual regularity, and improve overall health and wellbeing.
