AMENORRHOEA, OLIGOMENORRHOEA & HYPOMENORRHOEA

• Amenorrhoea - absence of menstruation for more than 6 months
• Oligomenorrhoea - menstrual bleeding occurs more than 35 days apart and remains constant at that frequency
• Hypomenorrhoea - menstrual bleeding is unduly scanty and lasts for less than 2 days
• Physiological Amenorrhoea – Primary (before puberty) & Secondary (during pregnancy, during lactation, following menopause
• Pathological Amenorrhoea – Concealed (Cryptomenorrhoea) & True (Primary & Secondary)

Primary Amenorrhoea

• Hyper gonadotropic (Turner’s syndrome, Gonadal dysgenesis, etc.)
• Hypogonadotropic hypogonadism (delayed menarche, Kallman’s syndrome, etc.)
• Normogonadotropic (Androgen insensitivity syndrome, Mullerian agenesis - MRKH syndrome, etc.)

Secondary amenorrhoea

• PCOS
• Premature ovarian failure
• Tubercular endometritis
• Asherman’s syndrome
• Sheehan's syndrome
• Pituitary adenoma (prolactinoma)
• Hyperprolactinemia
• Hypothyroidism
• Cushing’s syndrome
• Adrenal hyperplasia
• Malnutrition
• Psychogenic shock
• Stress

• Primary amenorrhoea – absence of menstruation by 16 years of age in the presence of normal secondary sexual characters, or by 14 years of age in the absence of secondary sexual characters
• Secondary amenorrhoea – absence of menstruation for six months (three normal cycles) with previously normal menstruation or absence of menstruation for 12 or more months following oligomenorrhoea
• Cryptomenorrhoea - Periodic shedding of endometrium and bleeding, but due to obstruction in the genital tract menstrual blood fails to come out
• Causes of cryptomenorrhoea- Congenital (Imperforate hymen, Transverse vaginal septum) & Acquired (Stenosis of Cervix following amputation, deep cauterization, etc; Secondary vaginal atresia)

• Exclude pregnancy by UPT etc
• Serum TSH, Prolactin level (Hyperprolactinemia - > 25 ng/mL)
• If prolactin level > 100 ng/ mL, X ray/CT/MRI for diagnosing pituitary adenoma
• Progesterone challenge test–
  • The patient is administered progesterone tablets for 5 to 10 days
  • If withdrawal bleeding occurs - Intact HPO axis, normal oestrogen secretion and there is progesterone deficiency Diagnosis – ovulation issues and the common cause is PCOS
  • If there is no withdrawal bleeding - Do Estrogen – Progesterone challenge test. Give OCP or oestrogen tablets for 25 days + progesterone tablets from day 15 to 25. If bleeding occurs, it denotes deficiency of oestrogen as well
• FSH & LH
  • High FSH & LH - Premature ovarian failure, resistant ovarian syndrome 
  • Low or Normal FSH & LH - Hypothalamus or Pituitary issues
• Estrogen – Progesterone challenge test
• if there is no withdrawal bleeding- endometrium is non-responsive or uterine synechiae
• Other investigations according to the suspected causes 

Primary amenorrhoea: 

• Correct the underlying causes
• Oestrogen replacement therapy
• If pituitary tumour - surgical resection, radiation, and drug therapy
• Surgery to correct abnormalities of the genital tract

 Secondary amenorrhoea:

• Cyclic progesterone
• Bromocriptine to treat hyperprolactinemia
• GnRH: when the cause is hypothalamic failure
• Thyroid hormone replacement

Ayurvedic Treatment

Internal Medicines

• Saptasara Kashaya
• Kana Shatahvadi Kashaya
• Tila Kashaya
• Sukumara Kashaya
• Chitraka Grandyadi Kashaya
• Lasuna Erandadi Kashaya
• Kumaryaasava
• Abhayaarishta
• Raja Pravartini vati
• Nastha Pushpanthaka rasa
• Shatapushpa choorna + Gritha /Tila taila
• Hinguvachadi choorna
• Pulim Kuzhambu
• Sukumara Gritha
• Sathavari Choorna
• Sathavari Guda

Procedures

• Snehapana
• Vamana 
• Virechana – Kalyana guda
• Vasti 
• Uttara Vasti
• Snehapana & Vasti – Tila Taila, Murchita Sarshapa Taila, Pippalyadi Anuvasana Taila, Varunadi Gritha, Sukumara Gritha 
• Kashaya for Vasti – Eranda Moola Kashaya, Dashamoola Kashaya, Saptasara Kashaya