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How TCM Views the Development of Amenorrhea

In TCM, causes for amenorrhea or missed periods are nothing more than factors like emotions, diet, blood deficiency, and evils invasions such as dampness and coldness. These factors cause disharmonies in the heart, liver, spleen and kidney, as well as dislocation of the two extra meridians, the Thoroughfare Vessel and the Conception Vessel. The result is that blood and qi (vital energy) do not flow through the extra meridians smoothly, so they cannot reach to the uterus and form menses.

In order to facilitate clinical management, physicians usually differentiate the pathological changes of the body as either deficient or excess states.

Pathological development of missed periods from a TCM perspective.

Deficient states that result in the development of amenorrhea:
  • Deficiency of kidney-qi: kidney-qi is regarded as the power for menstruation in TCM. When kidney-qi deficiency occurs, the kidneys will then fail to produce a substance called tian gui, and the blood will not flush the Thoroughfare Vessel and Conception Vessel. This usually happens in aging, chronic illness or miscarriage.
  • Deficiency of kidney essence: kidneys store the essence; blood and essence are mutually transformed. Essence is the important source for blood formation. When there is inadequate essence, blood cannot accumulate in the uterus, and no menses are formed. This usually happens with overwork and after multiple pregnancies.
  • Deficiency of spleen and stomach: this means that the body's digestive and absorption functions are abnormal, which leads to poor transformation of nutrient essence for the production of blood and qi (vital energy). This usually happens with stress, overwork and an improper diet.

    Excess states that result in the development of amenorrhea:
  • Stagnation of qi and blood: This is usually due to emotional disorders. TCM believes normal emotional health depends on a smooth flow of qi (vital energy) and blood, which are mainly regulated by the liver. In cases of emotional disturbances, especially frustration and anger, the liver's regulating functions are impaired and a condition termed"stagnation of liver-qi" results. When internal qi and blood flow become disharmonious, the extra meridians are affected and the menses will not come regularly.
  • Obstructions in the extra meridians: When the body is attacked by exogenous evils like coldness and dampness evils, they tend to congeal and stagnate in the Thoroughfare Vessel and Conception Vessel, and therefore disturb the blood and qi flows. On the other hand, dysfunction in the spleen or kidney leads to phlegm and dampness formation internally. When they accumulate in the extra meridians or uterus, blockages form.
  • Excessive heat: this is a rare phenomenon, when the body has accumulated excessive heat evils, they dry up the blood fluid and cause missed periods.

    The table below provides a general reference for TCM pathological conditions that cause amenorrhea and their corresponding western diagnosis.

    TCM Syndrome Patterns
    Western Diagnosis
    Kidney deficiency
    Poor development of ovaries
    Emotional and physical stress
    Chronic (long-term) illness
    Major bleeding during delivery or miscarriage
    Long-term breastfeeding
    Infections of the reproductive organs
    Postpartum pituitary insufficiency
    Hyperactive fire due to yin deficiency
    Ovarian problems such as premature ovarian failure (menopause before age 40)
    Kidney deficiency and phlegm obstruction
    Polycystic ovarian disease
    Endocrine disorders such as Cushing Syndrome
    Yin deficiency in the liver and kidneys
    Pituitary tumor
    Galactorrhea amenorrhea syndrome
    Stagnation of blood and qi
    Miscarriage or delivery that causes damage to the uterus
    Dysfunction in the heart, spleen and kidneys
    Emotional and physical stress