• 介绍　　　　　• 一览表　　　　　• 症状　　　　　• 治疗
• 饮食习惯的改变　　　• 生活方式的改变　　　• 营养补充剂
• 草药　　　　　　• 整体疗法　　　　• 参考资料

　　闭经是指妇女没有月经周期。

　　闭经分为原发和继发，前者是指女性在16岁时仍未有初潮；后者是指原本有正常月经周期的妇女出现不正常的闭经[1]。对于闭经的妇女，其女性的性激素水平不足以刺激月经形成。这种情况有时与营养不良联系，例如神经性厌食症，或运动过度导致机体对营养和其它供应有更高需求[2,3]。关于闭经与压力的关系也已被阐明[4]。闭经也可能是卵巢，下丘脑或垂体的潜在严重病变所引起；因此，医师应该仔细分析长期慢性的闭经。长期的闭经可以导致骨质的提前丢失，并增加骨质疏松的几率[5]。在生理条件下，哺乳期妇女是没有月经的[6]，但在此种情况下，没有骨质丢失的危险[7]。

闭经的辅助疗法

闭经的症状

　　闭经的妇女可能有的症状包括月经周期的缺乏，面部毛发增多，阴毛、腋毛减少，音调低沉，乳房变小及乳头异常分泌物。

医药治疗

　　治疗闭经的处方药包括避孕药(Ortho Novum®, Loestrin®, Mircette®, Triphasil®)，氯底酚胺(Clomiphene) (Clomid®, Serophene®)；或促性腺激素释放激素（GnRH）治疗法，包括纳法雷林(Synarel®) 和安希雷林（andhistrelin）(Supprelin®)。

可能有益的饮食习惯

　　人们早已知道，极端的限制饮食可以导致闭经[8,9]。当这种限制来自进食紊乱，例如厌食和易饿病[10]，专业的治疗就很必要。闭经的女性运动员可能是由于卡路里和其它营养成分摄入不足，有研究表明，当给她们的食谱上添加含有卡路里，蛋白质，糖类，脂肪，维生素，矿物质的营养饮料时，她们可以恢复月经[11,12]。然而，实验中，这些女运动员也降低了她们的运动量，这也可能对她们恢复月经周期有益处。

　　若和月经周期正常的妇女比较，月经次数少或闭经的妇女的食物中常常会有脂肪（尤其是饱和脂肪酸），蛋白，总卡路里较低的问题；此外她们的食谱中糖类和纤维素的比例较高[13,14,15]。在针对没有显著进食障碍的正常体重的妇女的初步研究中，可以用“接近正常，但缺乏脂肪”来形容有着闭经的妇女的食谱。这些妇女体内脂肪含量也相对较少[16,17]。在一项研究中，当妇女增加脂肪摄入量4个月后，她们的月经周期恢复正常，体内脂肪含量也回复正常[18]。

　　某些特殊的饮食习惯可能增加闭经发生的几率。一项初步研究发现，严格的生食习惯与体重下降和闭经联系紧密[19]。也有研究关注于素食主义者患闭经的易感性，但截至目前的研究结果还很不一致[20]。素食中可能富含一些被称为胡萝卜素的抗氧化剂。血液中有着较高胡萝卜素水平的妇女，较之于正常妇女，表现为更易出现闭经[21,22]；而且，尽管研究没有发现高胡萝卜素水平直接与闭经相关，但却可能是一个起作用的因素[23]。在一项初步研究中，有着高胡萝卜素水平的闭经的素食主义妇女，在减少了其食物中的胡萝卜素摄入量后，其血液中的胡萝卜素水平下降，闭经的情况也得到改善[24]。女性素食主义者常常主要依靠豆制品作为其蛋白质的来源，很多实验表明，豆类食物的过多摄入会降低绝经期前妇女的雌激素和孕激素水平[25,26,27,28,29,30]，尽管仍有一些实验没有得到类似结论[31,32]。在这些实验中，月经周期的改变并不一致，且没有一个实验发现高豆类饮食与闭经的联系。唯一的良好质控的对比实验发现：对于健康的，体重稳定的素食主义妇女，她们闭经的几率并不高于健康的，体重稳定的非素食主义妇女[33]。这项研究的作者推测：综合所有的证据和资料，素食习惯可能并不与闭经有联系。

可能有益的生活习惯

适量运动

　　对于绝经期前的妇女，适量运动对于整体健康有很多好处；但过量或剧烈运动可能导致闭经病增加提前骨质丢失的危险性，因为这对于整体的激素平衡不利[34]。一般说来，运动可以增加骨骼密度，但对于有着闭经的舞蹈者的研究发现，在持续两年的研究中[35]，她们的骨密度都低于正常值。如何解释女性演员和运动员闭经的现象，可能和她们当中高比例的进食障碍有关。再加上她们经常运动，有着更高的体力和营养要求，于是可能导致她们的营养缺乏和机体脂肪比例下降，进而导致闭经和骨质丢失[36,37,38]。跑步和芭蕾舞是与闭经联系最为紧密地运动[39]，有66%的女长跑运动员和芭蕾舞演员经历过闭经[40]。而对女性健美运动员的研究发现，81%经历过闭经，且很多有着营养缺乏的饮食习惯[41]。研究表明，当每周给以一天休息并每天服用含有添加卡路里，蛋白质，糖类，脂肪，维生素和矿物质的饮料的情况下[42,43]，一些闭经的女运动员恢复了月经周期。但此项研究没有设置对照。

哺乳期激素水平变化

　　在健康女性中，哺乳期的激素水平变化同样可以导致闭经[44]。这种月经周期的变化，被称为哺乳期或产后闭经，与很多因素有关，包括产妇的营养健康状况。在发展中国家，当产妇的营养状况较差时，哺乳期闭经的时间可能较长[45,46,47,48]，同样的情况在英国的卫生护理较差的女性中也可发现[49]。在美国，对于有着很好产后营养和护理的产妇的研究发现，较好的产妇营养状况，与较短的哺乳期闭经时间相关[50]。根据一项初步研究，当给予营养不良的产妇食物添加剂，无经期的长度可以缩短[51]。然而，一项对照实验[52]发现，在营养和护理条件较好的产妇，给予脱脂乳的食物补充，并不能减少无经期的长度。尽管延长的哺乳期闭经可以防止再次怀孕，但却并没有发现导致不可逆的骨质丢失[53]。

过度压力

　　过度的压力可以导致机体产生更多的肾上腺皮质激素考的松，有些研究发现高水平的考的松，与低水平的性激素联系，并可能导致闭经[54,55,56]。一项研究发现：相对于有正常月经周期的妇女，闭经的妇女对于压力有更高的考的松反应[57]。还没有研究来评估采用减小压力来治疗闭经的可行性。

戒烟

　　吸烟可能导致闭经。一项调查[58]显示，每天吸一包烟或更多的青年女性，更有可能闭经。然而，戒烟是否会使闭经妇女的月经周期正常化，仍然未知。

可能有益的营养补充剂

孕激素

　　已经至少有一项双盲实验表明[59]：口服型孕激素粉（每天200-300毫克）成功的使继发性闭经的妇女恢复月经。需要注意的是，激素治疗一定要在医生的指导下进行。

钙、维生素D

　　一项初步研究表明：尽管一年中每天补充1200毫克的钙和400国际单位的维生素D，闭经的女运动员仍然出现了骨质丢失的现象[60]。在一项对于闭经女护士（她们曾经历短暂的骨质丢失，但当月经正常时，不再丢失）的对照研究中，采用维生素复合制剂（400国际单位的维生素D和500毫克的钙）或安慰剂，每天两次。研究发现处理和对照之间没有显著差异[61]，都无法避免骨质丢失。尽管仍然缺乏仅用钙和维生素D可以对无经期妇女有利的证据，但它们仍在广泛使用，以预防钙和维生素D的缺乏所导致的骨质丢失[62]。每日推荐量为：钙1200-1500毫克，维生素D400-800国际单位。

乙酰左旋肉碱

　　乙酰左旋肉碱是一种氨基酸，可能对控制女性性激素的脑部化学物质和激素有效果。在一项初步实验中，对血液中雌性激素水平或低或正常的闭经女性，给予每天2克的乙酰左旋揉肩。发现：对于之前雌性激素水平较低的女性，用药后激素水平上升；所有女性受试者中，有一半人在用药3-6个月后恢复了月经[63]。为了确认这个有意义的结果，需要进一步的对照实验。

维生素C

　　一项初步研究表明[64]，仅管维生素C（每天400毫克）可以使一些原本月经正常但不排卵的妇女排卵，但仅使用维生素C对于闭经没有效果。在此研究的第二阶段，当采用维生素C和一种影响雌性激素水平的药物合用时，可以使半数的受试的闭经妇女恢复排卵，而单独使用此种药物没有这样的效果。为了弄清维生素C与闭经的关系，需进行更进一步的研究。

催乳激素

　　催乳激素是一种在某些闭经情况下升高的激素。一项针对三名有着高催乳激素水平的闭经女性的初步研究[65]发现，每天给予200-600毫克的维生素B6可以使月经周期恢复；然而即使是600毫克/每天的维生素B6也不能使非催乳激素升高型闭经妇女的月经周期恢复。一些列其它小型的初步试验[66,67,68,69,70]并没有证实口服或注射的维生素B6与体内催乳激素水平的关系，对于是否恢复月经周期，这些研究的结果也并不一致[71,72,73]。还需要更大一些的对照实验来确定维生素B6对于调理闭经的功能。

锌

　　尽管锌被认为对于生殖功能有着多方面的作用，但其与闭经的关系，却几乎没有研究设计[74]。在一项针对高强度练习的运动员的研究中，发现运动员有闭经与锌的缺乏无关[75]。因此需要更多的研究。

有无副作用及药物之间相互作用？

请参考各种营养补充物的副作用及相互作用。
 
可能有益的草药

蓝籽类叶牡丹

　　蓝籽类叶牡丹是对于月经缺乏的传统疗法。它被认为是一种通经剂（刺激月经血流的物质）和子宫滋补剂。还没有临床实验证实这种传统用法的科学性。

　　其它草药通经剂，如益母草，芸香，越桔，西洋蓍草，传统上被认为可以改善月经过少或闭经。以上所有草药都没有进行过关于对闭经疗效的现代临床实验。所有的通经剂都应该避免在怀孕期使用，因为它们可能会导致流产。

圣洁莓

　　在运用草药的医学中，圣洁莓（Vitex agnus-castus）(贞节树)有时被用于治疗女性不育和闭经[76]。催乳激素水平升高可能导致闭经，而圣洁莓在动物实验中被证实可以降低催乳激素水平[77]。在一项对照实验中，使用三个月的圣洁莓治疗后，原本催乳激素水平升高的女性的该激素水平变为正常[78]。研究还发现[79]：在黄体期缺陷的妇女（一种同样可能导致月经不调，包括闭经的疾病），圣洁莓可以提高黄体酮和之后孕激素的水平。到目前为止，只有一个小型的初步试验用于研究圣洁莓用于闭经的疗效。该研究发现：在持续六个月，每天一次服用40滴液体圣洁莓制剂的15名闭经的女性中，有10人恢复了正常的月经周期[80]。还需要进一步的研究来探究圣洁莓在对于闭经的调理中起到的作用。

有无副作用及药物之间相互作用？

请参考各种草药的副作用及相互作用

可能有效的整体疗法

　　一系列初步试验显示[81,82.83]，在有排卵异常的妇女（包括无排卵）中，针灸具有促进排卵的作用。初步研究发现：针灸可以提高机体的雌激素，孕激素，以及相关的黄体生成素和卵泡刺激素水平[84,85]。几乎没有研究涉及针灸对于闭经的治疗作用，但一项初步试验表明，针灸对于月经间隔过长的妇女有效[86]。在一项对照实验中，针灸之后，闭经妇女表现出恢复正常激素水平的趋势[87]。

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