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Secondary Amenorrhea

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Menstrual_Cycle_bottomWhat Is Secondary Amenorrhea?

Secondary amenorrhea is a menstrual disorder characterized by absence of menstruation for more than 3 months in females who had previously menstruated.

Menstruation is the shedding of the endometrium (inner lining) of the uterus that occurs two weeks after ovulation if the egg is not fertilized. The process is part of the menstrual cycle in fertile females.

Q: What causes failure to menstruate?

A: There is a variety of causes that include malnutrition, hormonal dysfunction, excessive exercise, mental stress, and chronic disease such as hypothyroidism and sarcoidosis.

What Is Secondary Amenorrhea In Celiac Disease and/or Gluten Sensitivity?

  • Relationship between secondary amenorrhea and celiac disease. Secondary amenorrhea is a classic symptom of celiac disease and can be a presenting feature of celiac disease.
  • Relationship between secondary amenorrhea and reproduction. Celiac disease may impair the reproductive life of affected women by causing amenorrhea.1
  • Relationship between secondary amenorrhea and diet. Researchers demonstrated that adolescents with celiac disease who were not adherent to a gluten free diet presented delayed menarche and secondary amenorrhea.2

How Prevalent Is Secondary Amenorrhea In Celiac Disease and/or Gluten Sensitivity?

Researchers studying amenorrhea demonstrated that amenorrhea is frequently associated with celiac disease.

In one study 38.8 % of patients with celiac disease complained of amenorrhea compared with 9.2% of controls.3

In a later study 19.4% frequency of amenorrhea was reported among celiac women versus 2.2% among healthy controls.4

What Are The Symptoms Of Secondary Amenorrhea?

  • Secondary amenorrhea is marked by abnormal absence of menstruation.
  • A female with amenorrhea will have no menstrual flow, with or without, other signs of puberty.
  • Possible acne due to androgen sensitivity (male hormones) which is an associated disorder of celiac disease.

How Does Secondary Amenorrhea Develop In Celiac Disease and/or Gluten Sensitivity?

  • Secondary amenorrhea results from endocrine dysfunction involving gluten exposure and one or more nutritional deficiencies in celiac disease that include calcium, magnesium, vitamin D, omega-6 fatty acids. Pathogenesis still awaits clarification.1

Does Secondary Amenorrhea Respond To Gluten-Free Diet?

The possible prevention or treatment of amenorrhea in celiac disease can only be achieved through a life-long maintenance of a gluten free diet.1

6 Steps To Improve Secondary Amenorrhea In Celiac Disease and/or Gluten Sensitivity:

Treatment. This condition responds to the complete elimination of gluten, which is the required treatment that improves both reproductive and gut health.

  • Gut health is the foundation to restore ALL health. Restored health will enable you to maintain a strict gluten free diet, just as other life tasks will be easier.
  • A strict gluten free diet means removing 100% of wheat, barley, rye and oats from the diet.
  • Cutting out bread and other obvious sources of gluten is not good enough for recovery. Even 1/8th teaspoon of flour or bread crumb is enough to sustain the inflammation that is damaging your small intestine, causing increased permeability (leaky gut) and allowing undigested gluten to enter your body where it can damage structures and function, and instigate immune inflammatory responses.

Correct Your Individual Nutritional Needs.

Recovery. You should begin to feel better within a week and notice more energy as inflammation subsides and the  absorbing cells that make up the surface lining of your small intestine are better able to function.

  • Intestinal lining cells are replaced every 5 days. The healing process is like sunburn where the damaged surface layer of skin sloughs off and is replaced with new normal cells.
  • Leaky gut normally resolves in two month after starting a gluten free diet and brings about a big improvement in health. Improvement in intestinal permeability precedes morphometric recovery (cell appearance and structure) of the small intestine in celiac disease.5
  • The intestinal lining may take up to a year to heal.
  • 2 Reduce Inflammation. Foods to Eat and Foods Not to Eat:

Because gluten is inflammatory, eliminate OTHER inflammatory foods from your diet to reduce an additive effect to gluten. At the same time, try to eat foods that reduce inflammation (anti-inflammatory).

Here Are Major Inflammatory Food Types That Reduce Healing:

  • Damaging Foods. In susceptible persons, includes corn, dairy (cow), and soy. Lactose, the sugar in any animal milk disrupts intestinal permeability causing leaky gut.6
  • Allergenic Foods. Includes foods that trigger the immune sytem to produce IgE antibodies. Allergy testing is the usual way to discover these offending foods.
  • Shelf Stable Processed Foods. Includes any that contain additives and preservatives. Look for them on the nutrition label of the box or package. Additives and preservatives also disrupt intestinal permeability causing leaky gut.6
  • Fats. Limit deep fried foods, trans-fats, saturated fats (animal fat/butter), and EXCESSIVE omega-6 fatty acid oils like corn oil. Rancid fats, sodium caprate (a medium chain fat), and sucrose monester fatty acid (a food grade surfactant) induce significant disruption of the intestinal barrier that causes leaky gut.6.
  • Excessive Refined White Flours (bran layer removed)Includes products made from them such as cookies, bread, cakes, pies. Bran contains the vitamins and minerals that metabolize grains and slows the otherwise rapid entry of sugar from their digestion into the bloodstream. Also disrupt intestinal permeability causing leaky gut.6
  • Refined Sugars.  Includes white sugar, corn fructose and high fructose corn syrup.
  • Certain Spices. Includes paprika and cayenne pepper which disrupt intestinal permeability causing leaky gut.6
  • Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.6

Here Are Important Anti-Inflammatory Food Types to Promote Health:

  • Fruits. Contain ample amounts of vitamins, minerals and phytochemicals which are naturally occuring components in plants that detoxify toxins, carcinogens (reducing the risk by 50%) and mutagens.
  • Non-Starchy Vegetables. Support intestinal integrity and provide ample amounts of vitamins, minerals and phytochemicals. Includes lettuce, kale, onion, broccoli, garlic, and others.
  • High Quality Complex Carbohydrates. Provide vitamins, minerals, and fiber while boosting serotonin levels to help you relax and feel calm. Includes whole grains, legumes, and root vegetables such as carrots, parsnips, sweet potatoes, turnips, red beets, and others.
  • Antioxidants. Protect the body from inflammatory oxidant molecules that continually occur and help us handle stress and reduce irritability. Includes vitamin C-containing foods such as lemon, grapefruit, apricot, Brussels sprouts and strawberries, and others. Also, includes vitamin E-containing foods such as nuts, seeds, avocado, olive oil, and others. Cocoa is good, too.
  • Omega-3 Fatty Acids. Balance opposing omega-6 fatty acids and bad fats. Fish sources includes tuna, salmon, cod, and others. Plants sources include flax, chia seeds, canola oil, and others.
  • Probiotics. Supply normal microbes needed for colon health and health of the body such as these fermented foods: yogurt, kefir, and unpasteurized apple cider vinegar.
  • Prebiotics/ High Fiber Foods.  Food with fiber keeps our population of colonic microbes healthy.
  • Protective Herbs and Spices.  See below #6 below for examples.
  • 3 Information Sheet You Can Take to Your Doctor or Other Health Professional:

Click here.

  • 4 Manage Your Medications Safely:

Certain medications cause deficiencies of calcium, magnesium, vitamin D and omega-6 fatty acids that can cause secondary amenorrhea.  Ask your doctor or pharmacist about this possible adverse effect if you are taking any of the drugs listed below.  Do not stop prescribed medications without supervision.

 This is not a complete listing.

ANTACIDS / ULCER MEDICATIONS

ANTIBIOTICS disrupt intestinal permeability which complicates celiac disease.

ANTI-INFLAMMATORIES disrupt intestinal permeability which complicates celiac disease.

ANTICONVULSANTS

  • Phenobarbital and Barbituates; and Dilantin®, Tegretol®, Mysoline®, Depakane/Depacon® deplete Calcium, Vitamin D.

ANTIVIRAL AGENTS

CHOLESTEROL DRUGS

  • Colestid® and Questran® deplete Vitamin D.

DIURETICS

  • Thiazide Diuretics (Hydrochlorothiazide, Enduron®, Diuril®, Lozol®, Zaroxolyn®, Hygroton® and others) deplete Magnesium.
  • Loop Diuretics (Lasix®, Bumex®, Edecrin®) depletes Calcium, Magnesium.
  • Potassium Sparing Diuretics (Midamor®, Aldactone®, Dyrenium® and others) deplete Calcium.

FEMALE HORMONES disrupt intestinal permeability which complicate celiac disease.

  • Oral Contraceptives (Norinyl®, Ortho-Novum®, Triphasil®, and others) deplete Magnesium.
  • Oral Estrogen/Hormone Replacement (Evista®, Prempro®, Premarin®, Estratab® and others) deplete  Magnesium.
  • 5Nutritional Supplements To Help Correct Deficiencies:

The type and quantity of nutritional supplements that may be needed depend on which nutrients are deficient.

  • Multivitamin/mineral combination of 100% once a day is useful to improve overall nutrient levels. This is a safe dose, but always check with your doctor to avoid interactions with medications.
  • Calcium citrate is the best absorbed of calcium supplements. Calcium carbonate is a poor choice.
  • Vitamin D3 as prescribed following blood test for status.
  • Chelated magnesium  as prescribed but do not take at same time as calcium because they compete for absorption.

Storage NoteStore container tightly sealed, away from heat, moisture and direct light to avoid loss of potency. That is, in a safe kitchen cabinet – not in the bathroom or on the kitchen table.

  • 6Manage Natural Remedies: 

Hydration:

  • Eight glasses of water are recommended per day unless there is a contraindication such as kidney or heart disease. The Institute of Medicine recommends approximately 2.7 liters (91 ounces) of total water, from all beverages and foods, each day for women and 3.7 liters (125 ounces) daily of total water for men.
  • If you are thirsty, drink water. Add fresh, squeezed lemon to water. Lemon is anti-inflammatory, alkalizing and provides vitamin C.
  • Hydration Test: Urine should be pale yellow. Fingertips should be plump, without pruning but this may not be reliable when fingers are swollen with edema. Lips should be plump, without puckering. The feeling of thirst can be unreliable.
  • What is wrong with soda, coffee, tea, and alcohol? These drinks are dehydrating, increase acid, and deplete nutrients.

Carminatives. The following  anti-inflammatory plant sources called carminitives help heal the digestive tract. They also tone the digestive muscles which improves peristalsis, thus aiding in the expulsion of gas from the stomach and intestine to relieve digestive colic and gastric discomfort.

Carminative Food Remedies:

  • Raspberry.
  • Carrot is also a cleansing digestive tonic.
  • Grape is also bile stimulating and a cleansing remedy for sluggish digestion and laxative.
  • Redbeets also stimulate and improve digestion and are easily digested.
  • Cabbage also stimulates and improves digestion and is also a liver decongestant.
  • Lettuce also stimulates and improves digestion and is also an alterative, meaning it improves the function of organs involved with the digestion and excretion of waste products to bring about a gradual change.
  • Potatoes are antispasmodic (due to atropine like properties) and a liver remedy.

Carminative Herb Remedies:

  • Sage is also a digestive, astringent, bile stimulant and energy tonic that heals the mucosa.  Drink as tea or use in cooking.
  • Chamomile, lemon balm, and fennel, (as a tea) also help relieve nervous tension.
  • Parsley also relieves indigestion.
  • Rosemary as a tea and in cooking also is a nervous system tonic for stress and fatigue, bile stimulant, and can relieve headaches and indigestion.
  • Thyme is also soothing remedy useful for stimulating digestion of rich, fatty foods.

Carminative Spice Remedies:

  • Cloves are also antispasmodic.
  • Nutmeg is also useful for indigestion.
  • Ginger.
Exercise Helps:

Exercise improves circulation and rids the body of toxins.

Note: Exercise is important, but the amount and type of exercise undertaken depends on your health. Your first priority is to heal.

What Do Medical Research Studies Tell About Secondary Amenorrhea In Celiac Disease and/or Gluten Sensitivity?

RESEARCH STUDY SUMMARIES

Reproductive life disorders in Italian celiac women.” This study investigating the association between celiac disease and menstrual cycle, gestation and puerperal disorders found a significant correlation between celiac disease and reproductive disorders.

62 celiac women (median age: 31.5, range: 17-49) and 186 healthy control were interviewed. A higher percentage of menstrual cycle disorders was observed in celiac women. 19.4% frequency of amenorrhea was reported among celiac women versus 2.2% among healthy controls.

An association was observed between celiac disease and oligomenorrhea, hypomenorrhea, dysmenorrhea and metrorrhagia. Although only a small number (4.8%) of the celiac women enrolled in this study  reported a menstrual cycle disorder as the onset symptom of their disease, almost half of the celiac women with at least one menstrual cycle disorder have reported that this/these latter appeared before the other typical symptoms/signs of celiac disease. Almost 70% of the celiac women with menstrual cycle disorders have reported that their diagnosis of celiac disease had been made after the onset of menstrual alterations. 70% of the celiac women with menstrual cycle disorders have reported that they did not follow a gluten free diet.7

“Gynecologic and obstetric findings related to nutritional status and adherence to a gluten-free diet in Brazilian patients with celiac disease.” This study analyzing gynecological disturbances in patients with Celiac Disease in relation to their nutritional status and adherence to a Gluten Free Diet demonstrated adolescents who were not adherent to a Gluten Free Diet presented delayed menarche and secondary amenorrhea. Gluten could explain the disturbances and malnutrition would worsen the disease in a consequent vicious cycle. Celiac disease should be included in screening of reproductive disorders.2

“Obstetric and gynecological problems in women with untreated celiac sprue.” This study investigating the gynecological history of newly diagnosed patients with Celiac Disease demonstrated that amenorrhea is frequently associated with celiac disease. 38.8 % of patients with Celiac Disease complained of amenorrhea compared with 9.2% of controls.8

  1. Stazi AV, Mantovani A. A risk factor for female fertility and pregnancy: celiac disease. Gynecologica endocrinology: the Official Journal of the International Society of Gynecological Endocrinology. Dec 2000;14(6):454-63. [] [] []
  2. Kotze LM. Gynecologic and obstetric findings related to nutritional status and adherence to a gluten-free diet in Brazilian patients with celiac disease. Journal of Clinical Gastroenterology. Aug 2004;38(7):567-74. [] []
  3. Molteni N, Bardella MT, Bianchi PA. Obstetric and gynecological problems in women with untreated celiac sprue. Journal of Clinical Gastroenterology. Feb 1999;12(1)37-9. []
  4. Martinelli D, Fortunato F, Tafuri S, Germinario CA, Prato R. Reproductive life disorders in Italian celiac women. A case-control study. BMC Gastroenterol. 2010 Aug 6;10:89. doi: 10.1186/1471-230X-10-89. []
  5. Cummins AG, Thompson FM, Butler RN, et al. Improvement in intestinal permeability precedes morphometric recovery of the small intestine in coeliac disease. Clinical Science. Apr 2001;100(4):379-86. []
  6. Farhadi A, Banan A, Fields J, Keshavarzian A. Intestinal barrier: an interface between health and disease. Journal of Gastroenterology and Hepatology. 2003;18:479-91. [] [] [] [] [] []
  7. Martinelli D, Fortunato F, Tafuri S, Germinario CA, Prato R. Reproductive life disorders in Italian celiac women. A case-control study. BMC Gastroenterol. 2010 Aug 6;10:89. doi: 10.1186/1471-230X-10-89. []
  8. Molteni N, Bardella MT, Bianchi PA. Obstetric and gynecological problems in women with untreated celiac sprue. Journal of Clinical Gastroenterology. Feb 1999;12(1)37-9. []

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