There are few treatment options for women with post-pill amenorrhea (no menstrual period after getting off birth control pills) with no underlying health issues. They must simply wait until their body returns to normal. In this amenorrhea case study, a 26-year-old female presented with amenorrhea lasting for three years after getting off birth control, which she had been taking consistently for seven years, from 17 until 23. Her lab test results were normal, and her primary care physician had not offered any treatment options.
Based on her Traditional Chinese medicine (TCM) diagnosis, she started receiving weekly acupuncture using the combination of TCM acupuncture points and Master Tung’s points, chosen for their specific properties. The patient’s prognosis was good, and the patient’s menstrual cycle returned after the third session. Even though this case study is limited to one patient’s experience, the return of her menstrual cycle merits additional research into using acupuncture for treating amenorrhea.
What is Amenorrhea?
Amenorrhea is the absence of a menstrual cycle in reproductive-age women. Primary amenorrhea is when the period does not start by age 14. Secondary amenorrhea is the failure of a period to return after stopping for more than six months. Although not considered a disease, amenorrhea can be a symptom of another condition. Of course, amenorrhea is considered normal in postmenopausal, preadolescent, and pregnant females.
There are many causes of primary amenorrhea, including congenital anomalies, elevated follicle-stimulating hormone (FSH) levels, hypothalamic imbalance, and polycystic ovary syndrome (PCOS). Secondary amenorrhea can occur from hormone imbalance following pregnancy, lactation, thyroid dysfunction, hypothalamic-pituitary dysfunction, and endometrial lining suppression from birth control hormones.
Amenorrhea Case Study
Normal menstruation works by balancing hormones and providing feedback between the hypothalamus, pituitary gland, ovaries, and uterus. An issue affecting this normal function in a woman can trigger amenorrhea. According to her blood tests, the patient in this amenorrhea case study was not pregnant at the time of treatment, and her hormones were within normal range. However, she had been off birth control for several years and had not had a menstrual cycle since stopping. Although there is no Western medical treatment for secondary post-pill amenorrhea, this study demonstrates how acupuncture assisted in the return of the patient’s menstrual cycle.
Case History
The patient was a 26-year-old female presenting with symptoms of amenorrhea over the previous three years. She had been on birth control pills since age 17 and stopped at 23 because they began to make her anxious. She ate no gluten, dairy, or processed sugar. Her period began at age 15, and she had remained at the same weight. Her pulse was thready, and her tongue was pale and puffy, with slight teeth marks, and a thin white coat. Other symptoms included cold hands, feet, and emotional stress (she was a full-time student). She had no issues with digestion, urination, or sleep. Her bloodwork was normal.
Western and TCM Diagnosis
Her Western medicine diagnosis was secondary amenorrhea due to coming off of birth control, while her TCM pattern diagnosis was Liver Qi and Blood deficiency. Her pale tongue reflected blood deficiency, while the puffiness and teeth marks indicated dampness in the lower Jiao due to spleen qi deficiency. In addition, the patient’s thready pulse revealed blood deficiency.
TCM Treatment Principle
The practitioner sought to strengthen her Spleen qi and nourish the blood to restore menstruation.
Acupuncture Points for Amenorrhea
The practitioner selected acupoints based on principles of Channel and Meridian Theory and Master Tung theory, including:
- Ling Gu (22.05, Adroit bone) – adjusts the Qi.
- Huan Chao (11.06, Return to the Nest) – treats irregular menstruation.
- Fu Ke (11.24, Gynecology) – treats irregular menstruation, dysmenorrhea, and scanty menstruation.
- Zi Gong Xue (Ex, Uterus Point) – raises and regulates the qi for irregular menstruation.
- CV 3 (Zhongji) – treats disorders like amenorrhea, dysmenorrhea, fibroids, and uterine bleeding. Tonifies qi and generates blood, and regulates the penetrating and conception vessels.
- SP 6 (Sanyinjaio) -alleviates pain and regulates hormones and menstruation.
- SP 10 (Xuehai) – cools heat in the blood, tonifies, strengthens, and activates the blood.
- ST 36 (Zusanli) – Generates qi and blood to treat gastrointestinal discomfort, nausea, vomiting, stress, and fatigue.
- KI 6 (Zhaohai) – nourishes Kidney yin, calms the mind, cools the blood, strengthens the adrenal glands, and supports the nervous system.
Acupuncture Results
After three sessions, once a week, the patient’s menstrual cycle returned. The practitioner recommended continuing acupuncture for maintenance and continuing her diet.
Amenorrhea Case Study Discussion
Returning to a regular menstrual cycle after discontinuing oral contraceptives can be difficult since the synthetic hormones have significantly transformed the body’s natural feedback mechanism. However, non-invasive treatments like acupuncture to restore this function may reduce the risk of other side effects.
There are two birth control pills, the first containing estrogen and progestin and the second containing only progestin. Both have hormones that prevent pregnancy by stopping or reducing ovulation, thickening cervical mucus to keep sperm from entering the uterus, and thinning the lining of the uterus so that the fertilized egg is less likely to attach.
According to the Cleveland Clinic, a small percentage of women who take a combination of birth control pills have an elevated risk of deep vein thrombosis, hypertension, stroke, and severe side effects. In addition, although they are known to be safe and effective at a lower dosage, oral contraceptives have some side effects, including weight gain, amenorrhea, abdominal swelling, fatigue, and fluid retention.
Amenorrhea and TCM
In Traditional Chinese Medicine (TCM), the absence of a period (amenorrhea) is called Bi Jing. Bi means “shut,” ‘switch off, ‘closed.’ Jing means ‘menstruation,’ ‘meridian.’ There are different causes of amenorrhea from an acupuncture point of view – some include emotional stress, excess physical exercises, hereditary weakness, poor diet, and overwork. The pattern diagnosis is either Qi stagnation and blood stasis, or Qi deficiency and blood stasis, reflecting either an excess or deficient type of amenorrhea.
In either case, the condition impedes blood flow. Either a follicle does not reach a complete state of maturity due to a deficiency state, or ovulation fails to occur because it is blocked. Other contributing causes include:
- Hereditary weakness (kidney essence insufficiency)
- Excessive physical, mental, exercise or work (spleen and kidney qi deficiency)
- Overwork and poor diet (spleen and stomach qi deficiency)
- Chronic illness (impairment of qi and blood may indicate a blood deficiency)
- Emotional stress (liver blood stasis)
- Improper diet (spleen qi deficiency)
- Invasion of cold to the low abdomen (can lead to blood stasis)
- Damp phlegm obstructs the uterus, the Chong and Ren extraordinary channels are blocked, and stagnation obstructs the uterus)
At age 23, the patient in this amenorrhea case study stopped oral contraceptives when she began feeling anxious. Being a working, full-time student may have also increased her stress levels. Once stopping birth control, the patient felt less anxious, but her period did not return. At this point, her primary care physician diagnosed her with Post-Pill amenorrhea.
Conclusion
Amenorrhea, or the lack of a menstrual cycle, affects many women and can be detrimental to women seeking to get pregnant. Birth control pills further complicate matters because as synthetic hormones replace the body’s natural hormones, the feedback method that the body uses to control hormone release essentially shuts down. Therefore, restoring regular hormone release is essential to re-establishing a normal menstrual cycle, and this is what acupuncture successfully did in this amenorrhea case study.
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Reference
Szafranska V, Xu B, Murphy L, Park J, Feng T, et al. A Case Study of Amenorrhea Treated with Acupuncture. Asian Journal of Complementary and Alternative Medicine, Vol 9(2), 55-58:2021.
Focus Keyphrase: Amenorrhea Case Study
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