Late Menarche (Start of Periods)

What Is Late Menarche?

[dropcap]L[/dropcap]ate menarche is a menstrual disorder in girls characterized by abnormal delay of menstruation, with or without breast development. The menarche is the first menstrual period or the start of menstruation. It should start within 3 years of breast development which usually starts after 10 years of age.

Q: How does the delay of menstruation differ from the normal start?

A:  In temperate climates such as the United States, the  menarche starts at an average of thirteen and one half years or between 10 to 15 years. Conversely, late menarche means the start is abnormally delayed past 15 years.

Causes of late menarche include stress, excessive physical activity such as athletic competitions, chronic diseases such as anemia, autoimmune diseases such as celiac disease, diabetes and thyroiditis, and nutritional deficiencies.

What Is Late Menarche In Celiac Disease and/or Gluten Sensitivity?

• Relationship between late menarche and celiac disease. Late menarche is a classic reproductive symptom of celiac disease and may be an uncommon presenting feature of untreated celiac disease. Celiac disease may impair the reproductive life of affected females, eliciting delayed menarche.¹
• Relationship between late menarche and prolactin hormone. Hyperprolactinemia, or elevated prolactin, is a common symptom of celiac disease that results in delayed menarche.² Hyperprolactinemia affects 100% of untreated patients. Prolactin is a hormone produced by the the anterior pituitary gland that is transported by the bloodstream to stimulate estrogen hormone production in female sex glands. However, too much prolactin inhibits hormone production of estrogen in women.
• Relationship between late menarche and fertile life span. Untreated celiac women with an older age of menarche and a younger age of menopause were shown to have a shorter duration of fertile life span than did the control women.³

How Prevalent Is Late Menarche In Celiac Disease and/or Gluten Sensitivity?

Delayed menarche is frequently associated with celiac disease.⁴ Menarche is significantly retarded in patients with untreated celiac disease.⁵

What Are The Symptoms Of Late Menarche?

• Late menarche is marked by abnormal delay of initial menstrual period.

How Does Late Menarche Develop In Celiac Disease and/or Gluten Sensitivity?

• Although the pathogenesis of late menarche still awaits clarification,⁶ delayed menarche has been shown to result from endocrine dysfunction involving gluten exposure and nutritional deficiencies in celiac disease including zinc.
• Deficiencies that are involved include omega-6 fatty acids and cholesterol.⁷
• In celiac disease there is a high level of autoantibodies directed against self-antigens, so there could be antibodies against hormones or organs critical for pubertal development. Moreover, in celiac disease there could be a selective malabsorption of micronutrients essential for the metabolism of carrier or receptor proteins for sex hormones.⁵

Does Late Menarche Respond To Gluten-Free Diet?

Yes. Celiac disease-related delayed menarche responds to gluten free diet and is preventive of delay.¹,⁷,⁵

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

• [dropcap]1[/dropcap]Remove the Trigger. Maintain a Strict, Nutritious Gluten Free Diet:

[box type=”shadow” ]Treatment. This condition responds to the complete elimination of gluten, which is the required treatment that improves both menstruation 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.

• Eat foods that can replenish missing nutrients. Find them under NUTRIENT DEFICIENCIES.
• Take nutritional supplements as needed. Find them under NUTRIENT DEFICIENCIES.

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.⁸
• The intestinal lining may take up to a year to heal.[/box]

• [dropcap]2[/dropcap] 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).

[box type=”shadow” ]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.⁹
• 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.⁹
• 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.⁹.
• 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.⁹
• 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.⁹
• Alcohol and Caffeine. Disrupt intestinal permeability causing leaky gut.⁹[/box]

[box type=”shadow” ]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.[/box]

• [dropcap]3[/dropcap] Information Sheet You Can Take to Your Doctor or Other Health Professional:

Click here.

• [dropcap]4[/dropcap] Manage Your Medications Safely:

[box type=”shadow” ]

Certain medications cause deficiencies of  zinc and omega-6 fatty acids that can cause delayed menarche.  Ask your doctor or pharmacist about this possible adverse effect if you are taking medications. Do not stop prescribed medications without supervision.

 This is not a complete listing.

ANTACIDS / ULCER MEDICATIONS

• Pepcid®, Tagamet®, Zantac® deplete Zinc.
• Magnesium and Aluminum Antacid preparations (Gaviscon®, Maalox®, Mylanta®) deplete Zinc.

ANTIBIOTICS disrupt intestinal permeability which complicates celiac disease.

•  Tetracyclines deplete Zinc.
• Cipro depletes Zinc.

ANTI-INFLAMMATORIES disrupt intestinal permeability which complicates celiac disease.

• Corticosteroids (Prednisone, Medrol®, Aristocort®, Decadron) deplete Zinc.

ANTICONVULSANTS

• Phenobarbital and Barbituates; and Dilantin®, Tegretol®, Mysoline®, Depakane/Depacon® deplete Zinc.

ANTIVIRAL AGENTS

• Zidovudine (Retrovir®, AZT and other related drugs) deplete Zinc. 

DIURETICS

• Thiazide Diuretics (Hydrochlorothiazide, Enduron®, Diuril®, Lozol®, Zaroxolyn®, Hygroton® and others) deplete Zinc.
• Loop Diuretics (Lasix®, Bumex®, Edecrin®) depletes Zinc.
• Potassium Sparing Diuretics (Midamor®, Aldactone®, Dyrenium® and others) deplete Zinc. [/box]

• [dropcap]5[/dropcap]Nutritional Supplements To Help Correct Deficiencies:

[box type=”shadow” ]

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

• Multivitamin/mineral combination 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.
• Chelated zinc as prescribed but do not take at same time as calcium because they compete for absorption.

Storage Note: Store 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.[/box]

• [dropcap]6[/dropcap]Manage Natural Remedies: 

[box type=”shadow” ]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.[/box]

[box type=”shadow” ]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.[/box]

[box type=”shadow” ]Exercise Helps:

Exercise improves circulation and rids the body of toxins.

• Walking is aerobic exercise that reconditions the whole body to improve stamina. Read more about Exercise and Fitness.
• Weight training builds muscle. Read more about Exercise and Fitness.
• Stretching improves flexibilty. Read more about Exercise and Fitness.

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

Medical Research Findings On Late Menarche In Celiac Disease and/or Gluten Sensitivity:

RESEARCH STUDY SUMMARIES

“From menarche to menopause: the fertile life span of celiac women.” This study investigating menopause-associated disorders and fertile life span in women with celiac disease under untreated conditions and after long-term treatment with a gluten-free diet found that late menarche and early menopause cause a shorter fertile period in untreated celiac women compared with control women. Untreated celiac women had a shorter duration of fertile life span than did the control women because of an older age of menarche and a younger age of menopause.

The participants were 33 women with celiac disease after menopause (untreated celiac disease group), 25 celiac women consuming a gluten-free diet at least 10 years before menopause (treated celiac disease group), and 45 healthy volunteers (control group). The Menopause Rating Scale questionnaire was used to gather information on menopause-associated disorders. The International Physical Activity Questionnaire was used to acquire information on physical activity. A gluten-free diet that started at least 10 years before menopause prolongs the fertile life span of celiac women.¹⁰

“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.⁷

“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 delayed menarche is frequently associated with celiac disease.¹¹

Sources:

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. Sher KS, Jayanthi V, Probert CS, Stewart CR, Mayberry JF. Infertility, obstetric and gynaecological problems in coeliac sprue. Digestive Diseases. May-Jun 1994;12(3):186-90. [↩]
3. Santonicola A, Iovino P, Cappello C, Capone P, Andreozzi P, Ciacci C. From menarche to menopause: the fertile life span of celiac women. Menopause. 2011 Oct;18(10):1125-30. doi: 10.1097/gme.0b013e3182188421. [↩]
4. 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. [↩]
5. Bona G, Marinello D, Orderda G. Mechanisms of abnormal puberty in coeliac disease. Hormone Research. 2002;57(Suppl 2):63,3p. [↩] [↩] [↩]
6. 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. [↩]
7. 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. [↩] [↩] [↩]
8. 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. [↩]
9. 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. [↩] [↩] [↩] [↩] [↩] [↩]
10. Santonicola A, Iovino P, Cappello C, Capone P, Andreozzi P, Ciacci C. From menarche to menopause: the fertile life span of celiac women. Menopause. 2011 Oct;18(10):1125-30. doi: 10.1097/gme.0b013e3182188421. [↩]
11. 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. [↩]