What is Amenorrhoea? Definition, Classification, Symptoms, Diagnosis, Homeopathic Medicine

Definition :

• Amenorrhoea is an absence of menstrual flow occurring at any time between puberty and the menopause, except during pregnancy and lactation.

Aetiological classification :

Physiological :

• During pregnancy.
• Sometime during adolescence.
• Before puberty.
• After menopause.
• Sometime during lactation.

Pathological : 

Primary amenorrhoea: When menarche does not appear even when the girl is over 18 years.

• Cryptomenorrhoea. 
• Rudimentary or infantile uterus or ovaries. 
• Sex chromosomal defect. 
• Congenital absence of uterus or ovaries.
• Endocrinal cause - hypothyroidism, juvenile diabetes mellitus etc. 
• Injury or diseases of the midbrain.
• Turner's syndrome.
• Frohlick's syndrome.
• Tuberculosis, anaemia etc.
• Poor nutrition.
• Some drugs like androgens etc.    

Secondary Amenorrhoea: Cessation of menses for 3 or more months following normal menstruation.

• Uterine injury, tuberculosis, hysterectomy, radiation D & C etc.
• Cervical stenosis or amputation or cautery.
• Bilateral ovarian tumour.
• Premature menopause, bilateral oophorectomy. 
• Cushing syndrome, acromegaly.
• Psychological upset, anorexia Nervosa, mental disease, worry, emotional shock.
• Injury or disease of mind-brain.
• Hypo or hyperthyroidism.
• Kala-azar, Malaria, Typhoid fever, Diabetes, Alcoholism, poor nutrition obesity etc.

Symptoms : 

In chronic amenorrhoea, the symptoms are often only such as are characteristics of the pathological condition of which the amenorrhoea itself is but a symptom, and are better considered in connection with those conditions.
Acute suspension may give rise to symptoms which, in character and intensity, will vary from those of ordinary menstruation like backache, heaviness and weight, pelvic pains etc. To symptoms of pre-found disorders, leading sometimes to severe and dangerous diseases.

Diagnosis :       

Mainly self-evident diagnosis but in the pathological condition which produces it is often a matter of difficulty, and can only be accomplished by a thorough understanding of the respective states.

Investigations :

Causes of amenorrhoea are to be remembered and the investigation is to be conducted accordingly :

• Blood - Total count, Differential count, Hb%, E.S.R, Sugar, Cholesterol.
• Urine - Sugar, specific gravity. 
• X-ray of chest and pituitary fossa.
• Vaginal cytology.
• Hormonal assays. 
• Laparoscopy.
• Gynaecography.

Prognosis :

Prognosis mainly depends upon our ability to remove the existing cause and is usually favourable.

Management :

• In the place, it is a safe and proper rule to follow that no case of amenorrhoea require treatment so long as it presents no positively morbid symptoms, but in some cases of suppression and partial amenorrhoea usually demand medical aid.
• Reassurance.
• Removal of the cause.
• Improve general health by an adequate diet, maintaining personal hygiene.

Homeopathic remedies :

• Calcarea Carb

Especially useful in scrofulous or tuberculous subjects, fair, plump girls, of a leuco-phlegmatic temperament. Disturbance of indigestion, weary, languid, want of vitality and anaemia.

• Cimicifuga 

In rheumatic, neuralgic, choreic, or hysterical subjects, menses irregular, delayed or suppressed, ovarian irritation, uterine cramps, bearing down in the uterine region and small of the back, limbs heavy and torpid, suppression from cold or emotions, more generally useful in all classes of amenorrhoea than any other remedy.

• Graphites 

First menses delayed, or disturbances at the menopause. 

Graphites are in climax what pulsatilla is in youth.

Menses late, scanty and pale, pain in epigastrium as if everything would be torn to pieces. Induration of ovaries.

• Pulsatilla 

Anaemia without chlorosis. First menses delayed, menses late, scanty, and of short duration, suppressed from getting the feet wet. Heavy pressure pain in the abdomen and small of the back, as from a stone. Specially adapted to patients with light hair and blue eyes, and who are of gentle, submissive, tearful disposition.

• Phosphorus 

Amenorrhoea with blood spitting or haemorrhage from the nose, anus or urethra. Especially in tall, slender phthisical patients, dry cough and tight feeling in the chest. 

• Sepia 

Scanty or retarded mensturation in feeble women of dark complexion, leucorrhoea before the menses, like milk, excoriating, uterine displacement, face sallow, with yellow spots, bearing down pains, weakness and tired pain in small of back. 

Biochemic Remedies :

• Calcarea phosphorica 

This remedy is indicated  especially in anaemic conditions.

• Kali phosphorica

This remedy is indicated in retention or delay of the monthly flow and general nervous debility.

• Kali sulphuricum

This remedy is indicated in menses too late or scanty, with fullness and weight in abdomen. 

Colour of tongue

• Kali muriaticum

This remedy is indicated in lymphatic constitutions, white coated and inactivity of glandular system.