Hormonal Suppression and Menstrual Delay: Secondary Amenorrhea Associated with Prolonged Oral Contraceptive Use

Dr Amreen Begum; Syeda Abidunnisa; Zeba Altafhusain Lalkot; Safura Fatima; Farha Naaz

doi:10.36948/ijfmr.2026.v08i04.83447

Hormonal Suppression and Menstrual Delay: Secondary Amenorrhea Associated with Prolonged Oral Contraceptive Use

Author(s)	Dr Amreen Begum, Dr. Syeda Abidunnisa, Dr. Zeba Altafhusain Lalkot, Dr. Safura Fatima, Dr. Farha Naaz
Country	India
Abstract	ABSTRACT Introduction: Secondary amenorrhea — the cessation of menstruation for three or more consecutive cycles in a previously menstruating woman — is an increasingly recognised clinical consequence of prolonged oral contraceptive pill (OCP) use. In classical Unani medicine, this condition is described under the nomenclature Ihtibas-e-Tams or Ihtibase Haiz, attributed to disturbances in Mizaj (temperament) and Akhlat (humours), while modern gynaecology attributes it to hypothalamic-pituitary-ovarian (HPO) axis suppression from exogenous hormones. Objective: To evaluate the incidence, pathophysiology, and clinical management of secondary amenorrhea following prolonged OCP use through an integrated Unani-modern lens, identifying the pharmacological mechanisms of HPO suppression and correlating them with the classical Unani concept of Ihtibas-e-Tams. Methodology: A systematic literature review was conducted across classical Unani texts (Ibn Sina's Al-Qanun fil-Tibb, Jurjani's Zakhira-e-Khwarizm Shahi, Razi's Kitab al-Hawi) and modern databases (PubMed, Cochrane, WHO) covering the period 1985–2024, with 58 selected references. Observation: Post-pill amenorrhea affects approximately 0.7–3.1% of OCP users. Prolonged use suppresses GnRH pulsatility, blunts LH/FSH surges, and induces endometrial atrophy, mirroring the Unani concept of Ghilzat-e-Dam (blood thickening) and Zu'f-e-Quwwat-e-Dafi'a (weakness of expulsive faculty). Conclusion: Integrated management combining Unani regimenal therapy (Hammam, Riyazat), pharmacotherapy (Mudir-e-Haiz drugs), and modern hormonal assessment offers a superior therapeutic framework for OCP-induced amenorrhea.
Keywords	Keywords: Secondary Amenorrhea, Oral Contraceptives, Ihtibas-e-Tams, HPO Axis Suppression, Post-Pill Amenorrhea, Unani Gynaecology, Mudir-e-Haiz, Endometrial Atrophy
Field	Medical / Pharmacy
Published In	Volume 8, Issue 4, July-August 2026
Published On	2026-07-12
DOI	https://doi.org/10.36948/ijfmr.2026.v08i04.83447

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Hormonal Suppression and Menstrual Delay: Secondary Amenorrhea Associated with Prolonged Oral Contraceptive Use

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