Restoring a Regular Cycle with PCOS: Causes of Amenorrhea and Natural and Medical Solutions

A woman's menstrual cycle can become irregular at different stages of life due to various factors. We may experience amenorrhea, or the absence of menstruation, at different times. Factors such as significant weight loss can affect hormonal balance, while emotional disturbances or high stress levels can also disrupt the menstrual cycle. Additionally, a diet lacking in sufficient calories and essential nutrients can also imbalance hormones and affect menstrual regularity. These disruptions can lead to menstrual irregularities, such as longer or shorter cycles, or even a complete absence of menstruation, known as amenorrhea. Amenorrhea can also be a symptom of various hormonal disorders: PCOS, thyroid problems, elevated prolactin levels, or hyperandrogenism.

PCOS: Understanding Amenorrhea or Absence of Periods

Amenorrhea is defined as the absence of periods for several months. Amenorrhea can be primary (when periods never started) or secondary (a sudden stop of periods). Various causes can lead to this condition:

Causes of Amenorrhea

Amenorrhea, or the absence of periods, can be caused by various reasons. Here are the main causes to consider:

• Nutritional Deficiencies: A diet lacking essential vitamins and minerals can lead to an absence of periods. Nutrients play a crucial role in maintaining the hormonal balance necessary for the menstrual cycle. A diet too low in fats and lipids can disrupt ovarian hormone production, leading to menstrual cycle disorganization. Even a strict diet for three days can cause irregularities in the cycle. Excessive weight loss due to overly restrictive diets often leads to a complete stop of periods. The body needs a minimum amount of fat to maintain adequate hormonal production and regular menstrual cycles.

• Excessive Exercise and Amenorrhea: High-level athletes often experience amenorrhea due to excessive physical activity. Intense training and low body fat percentages can disrupt hormonal levels and thus interrupt menstruation.

• Infections and Amenorrhea: Viral or bacterial infections, such as SARS-CoV-2, can disrupt the menstrual cycle. Infections can affect the hypothalamus, pituitary gland, or ovaries, thereby disrupting hormonal regulation.

• Stress and Amenorrhea: Intense stress, whether physical or emotional, can interrupt menstruation. Stress affects the hypothalamus, which plays a key role in regulating the menstrual cycle.

• Stopping the Pill and Absence of Periods: After stopping the pill, amenorrhea can last up to 4 or 5 months. During pill use, monthly bleeding is not a true period, as ovulation is blocked. After stopping, the body needs time to restart its natural hormonal production and resume regular cycles. Each woman reacts differently: some regain their periods a few weeks after stopping the pill, while others may wait several months. Delayed periods are common during this hormonal rebalancing period. If the absence of periods extends beyond 4 to 5 months, it is recommended to consult a gynecologist or midwife, who can prescribe hormonal treatment to regulate the cycles. It is also possible to become pregnant even in the absence of periods, as ovulation may resume before menstruation. A pregnancy test can rule out this possibility.

Hormonal Causes of Absence of Periods

• Thyroid: Thyroid dysfunctions, whether hypothyroidism (underproduction of thyroid hormones) or hyperthyroidism (overproduction of thyroid hormones), can disrupt the menstrual cycle. Hypothyroidism can cause irregular menstrual cycles or amenorrhea by disturbing prolactin levels. Hyperthyroidism can also disrupt the menstrual cycle, although the effect is more variable.

• Primary/Pre-Menopausal Ovarian Insufficiency: Primary ovarian insufficiency (POI) is a condition where the ovaries stop functioning normally before age 40. Causes may include chromosomal abnormalities, autoimmune diseases, or medical treatments such as chemotherapy. POI leads to a significant decrease in estrogen production, which can cause amenorrhea. The ovaries no longer release eggs regularly, disrupting the menstrual cycle.

• Hyperprolactinemia (Excess Prolactin): Hyperprolactinemia is characterized by excessive levels of prolactin in the blood. Prolactin is a hormone produced by the pituitary gland that stimulates milk production after childbirth. High levels of prolactin can inhibit the secretion of gonadotropins (LH and FSH), hormones necessary for the menstrual cycle and ovulation. This can lead to amenorrhea.

• Hypothalamic or Pituitary Dysfunction: Dysfunction of the hypothalamus or pituitary gland, which regulate the release of reproductive hormones, can lead to the absence of periods. Stress, extreme weight loss, intense physical exercise, or tumors can affect the secretion of gonadotropins (LH and FSH), disrupting the menstrual cycle and potentially causing amenorrhea.

• Hormonal Imbalances (Estrogens, Androgens): Hormonal imbalances, such as excess or deficiency in estrogens or androgens, can disrupt the menstrual cycle. For example, a deficiency in estrogens can prevent the thickening of the uterine lining necessary for menstruation. An excess of androgens, as seen in polycystic ovary syndrome (PCOS), can also lead to irregular menstrual cycles or amenorrhea.

Polycystic Ovary Syndrome (PCOS)

PCOS and the Menstrual Cycle

Before concluding a diagnosis of Polycystic Ovary Syndrome (PCOS) in cases of absent periods, it is crucial to explore all other potential causes:

• Eating Disorders: Eating disorders, such as anorexia or bulimia, can disrupt the menstrual cycle.
• Ovarian Insufficiency: Premature ovarian insufficiency can lead to an absence of periods due to premature cessation of ovarian function.
• Rapid and Significant Weight Fluctuations: Significant weight fluctuations can disrupt hormonal balance.
• Thyroid Disorders: Both hypothyroidism and hyperthyroidism can lead to menstrual irregularities.
• Pituitary Adenoma with Hyperprolactinemia: A benign pituitary tumor producing prolactin can inhibit ovulation and menstruation.
• Psychological Trauma: Traumatic events can disrupt hormonal balance.
• Certain Medications: Some antidepressants and antipsychotics can cause amenorrhea as a side effect.

Once these causes are ruled out and a medical diagnosis is confirmed, PCOS can be considered as a potential cause of amenorrhea.

Polycystic Ovary Syndrome (PCOS) is a common hormonal condition in women of reproductive age. It is characterized by high levels of androgens, irregular menstrual cycles, and ovaries containing numerous small follicles. These hormonal imbalances disrupt ovulation and can lead to amenorrhea. PCOS is also associated with insulin resistance, which can worsen hormonal imbalances and menstrual issues.

PCOS - Menstruation

To understand the link between PCOS and amenorrhea, it is important to grasp how hormones regulate the menstrual cycle. Normally, the hypothalamus releases GnRH, which stimulates the pituitary gland to produce FSH and LH. FSH helps ovarian follicles grow, each containing an egg. Mature follicles produce estrogen, and increased estrogen triggers an LH surge, leading to ovulation, the release of the mature egg.

• Irregular Cycles and PCOS: Women with PCOS often have irregular menstrual cycles, meaning the time between cycles can vary considerably.

• Long Menstrual Cycles and PCOS: Menstrual cycles can be exceptionally long, often exceeding 35 to 40 days. This phenomenon is due to the absence of regular ovulation.

• Anarchic Cycles: Cycle irregularity can be extreme, with no apparent regularity in the occurrence of periods.

• Amenorrhea (Absence of Periods) and PCOS: Amenorrhea is common among women with PCOS and can manifest in two ways:

  • Primary Amenorrhea: Periods do not appear at puberty.
  • Secondary Amenorrhea: Periods stop after starting normally.

• Oligomenorrhea (Infrequent Periods) and PCOS: This term refers to infrequent periods, with cycles spaced more than 35 days apart.

• Menorrhagia (Heavy Periods) and PCOS: Some women with PCOS may also experience abnormally heavy and prolonged menstrual bleeding.

• Regular Cycles and PCOS: It is important to note that not all women with PCOS have irregular cycles. Some may have regular menstrual cycles despite a PCOS diagnosis. However, even with regular cycles, ovulation may be abnormal or absent (anovulation). This means that while periods occur at regular intervals, they may not reflect normal ovulation.

• Regular Cycles and Anovulation: Anovulation is a condition where the ovary does not release an egg during a menstrual cycle. This can occur even in women with regular menstrual cycles. In such cases, despite the apparent regularity of the cycle, the absence of ovulation can lead to fertility issues and hormonal imbalances. Regular cycles without ovulation may result in a lack of progesterone, as this hormone is produced after ovulation by the corpus luteum. The absence of progesterone can lead to excessive thickening of the uterine lining, potentially causing heavy or prolonged bleeding (menorrhagia).

Causes of Menstrual Disorders in PCOS

Menstrual Disorders in Women with PCOS

Menstrual disorders observed in women with PCOS are primarily caused by hormonal imbalances. PCOS disrupts ovulation and the production of essential hormones, including estrogens and progesterone, which are necessary for a regular menstrual cycle.

• Androgen Imbalance: PCOS is often associated with elevated levels of androgens (male hormones), which can inhibit ovulation and disrupt menstrual cycle regularity. Hyperandrogenism, or excess androgens, is a key feature of PCOS. While male hormones are present in small amounts in healthy women, they are produced in excess in those with PCOS. Elevated androgen levels interfere with normal follicular development, preventing follicles from maturing and releasing an egg. Consequently, menstrual cycles become irregular, with prolonged periods between menstruations or a complete absence of menstruation, known as amenorrhea.

• Insulin Resistance: Many women with PCOS exhibit insulin resistance, which can worsen hormonal imbalances and contribute to menstrual irregularities. Insulin resistance means that their cells respond less effectively to insulin. To compensate, the body produces more insulin, which can stimulate the ovaries to produce more androgens. This vicious cycle of insulin resistance and hyperandrogenism further disrupts the menstrual cycle.

• Ovulation Dysfunction: Irregular or absent ovulation is a key feature of PCOS. Without regular ovulation, the menstrual cycle becomes unpredictable and can lead to amenorrhea (absence of periods) or spaced-out cycles (oligomenorrhea).

• Inadequate Progesterone Production: In the absence of regular ovulation, progesterone production is insufficient. Progesterone is necessary to regulate the menstrual cycle and maintain the uterine lining.

Amenorrhea and Fertility: Implications

Amenorrhea caused by PCOS has major implications for fertility. Without regular ovulation, it becomes difficult for a woman to conceive naturally. PCOS is thus one of the leading causes of female infertility. Without treatment, women with PCOS may experience long periods of anovulatory cycles (without ovulation), significantly reducing their chances of conception.

Solutions to Trigger Menstruation

Naturopathy offers a holistic approach to promoting health and well-being through natural methods. When it comes to regulating the menstrual cycle, naturopathy is distinguished by its focus on addressing the underlying causes of hormonal imbalances and menstrual disorders.

One of the key approaches in naturopathy for regulating the menstrual cycle is micronutrition. This branch of nutrition focuses on the impact of micronutrients such as vitamins, minerals, and essential fatty acids on health. Micronutrient deficiencies can disrupt hormonal function and affect the menstrual cycle. For instance, iron deficiency can lead to heavy menstruation, while an imbalance in omega-3 fatty acids can contribute to severe menstrual cramps.