Amenorrhea primary and secondary: causes and treatment

Primary amenorrhea is when a girl is still under the age of 16, and her menstrual cycle has not yet begun. Causes of Primary Amenorrhea include: ovarian dysfunction, changes in the nervous central system (brain or spinal cord), as well as thyroid dysfunction, which produces hormones needed during menstruation.

Amenorrhea secondary

Secondary amenorrhea is when it occurs during regular cycles, but can suddenly stop and last a month or more. The manifestation of amenorrhea can be accompanied by a number of different reasons. For example, reasons such as hormonal changes in the body of a woman or girl, as well as changes in the internal pelvic organs, which are responsible for the beginning of the menstrual cycle.

Causes of amenorrhea secondary include such as: breastfeeding,
Withdrawal of contraceptives, pregnancy or menopause.

Causes of Amenorrhea

Most often, the absence of menstruation has natural causes, such as pregnancy, breastfeeding, or menopause. However, this violation may be caused by other reasons.

Contraceptives

The absence of menstruation can be observed in women taking hormonal contraceptives. Restoring regular ovulation and menstruation after stopping contraception may take 3-6 months. Lack of menstruation can also cause contraceptive injections and some types of intrauterine devices.

Medicines

Menstruation may stop due to certain medications, including:

  • Antipsychotics
  • Chemotherapy drugs
  • Antidepressants
  • Drugs used to regulate blood pressure

Lifestyle Factors

Stress can temporarily change the functioning of the hypothalamus - the part of the brain that controls the production of hormones that regulate the menstrual cycle. As a result, ovulation and menstruation may stop. After reducing the level of stress, the menstrual cycle usually normalizes.

Body weight below normal can disrupt the functioning of hormones in the body, while ovulation is likely to stop. Especially often, the absence of menstruation is observed in women with eating disorders such as anorexia and bulimia.

Strong physical activity. The menstrual cycle is often disturbed in women who train a lot and for a long time - for example, they are professionally engaged in gymnastics, ballet, long-distance running. They are immediately affected by several factors associated with the risk of interruption of the normal menstrual cycle: low weight of fatty tissues, stress and high energy consumption.

Hormonal imbalance

  • There are many diseases that can cause hormonal imbalances, which, in turn, often lead to a lack of menstruation.
  • Polycystic ovary syndrome can cause a relatively high and stable level of hormones, while during the normal menstrual cycle, certain fluctuations in the hormonal background should occur.
  • Thyroid dysfunction - its increased activity (hyperthyroidism) or decreased activity (hypothyroidism) often causes malfunctions of the menstrual cycle, including the absence of menstruation.
  • A benign pituitary tumor can also cause a lack of menstruation.
  • Sometimes menstruation ceases due to premature onset of menopause. In most women, menopause begins at the age of 45-55, but for some it can happen before the age of 40.

Anomalies in the structure of the genital organs

The absence of menstruation can be the result of deviations in the structure of the genital organs, for example:

  • Scars on the uterus. In particular, the menstrual cycle may be disturbed due to Asherman's syndrome - a condition in which scar tissue forms on the inner lining of the uterus. This can occur after surgical abortion, cesarean section, or after treatment of uterine fibroids.
  • Lack of reproductive organs. It happens that girls are born without any parts of the reproductive system - for example, without the uterus, cervix or vagina. A normal menstrual cycle is not possible.
  • Structural abnormalities of the vagina. Obstruction of the vagina, for example, due to the fact that the hymen completely covers it, may be the reason for the absence of menstruation.

Treatment and diagnosis of amenorrhea

Diagnosis and treatment of amenorrhea should be professionally organized. First of all, it is advisable to take a medical history, gynecological examination. Along with them, laboratory diagnostics, ultrasound and other studies are used. Therapy is aimed at eliminating the cause, for which the use of hormonal drugs, surgical intervention can be effective. If the absence of menstruation was the result of severe stress, the doctor recommends rest, relaxing procedures, in extreme cases, a consultation with a psychiatrist.

Amenorrhea. Types, causes, treatment

Amenorrhea is a term used to describe the absence of menstruation in medicine. Amenorrhea can be primary when a woman has never had menstruation before, or secondary when a woman has had menstruation before.

Genetic or congenital abnormalities are the most common cause of primary amenorrhea. Menstruation may be absent as a result of an upset of the ovaries, pituitary, hypothalamus or uterus. Intense physical activity, excessive weight loss, various medical conditions and stresses - all this can also lead to amenorrhea.

Amenorrhea is a symptom, not a disease, so amenorrhea can be prevented only when the underlying cause is prevented.

Infertility and loss of bone density (osteoporosis) are potential complications of amenorrhea.

Treatment may include surgical correction of anatomical abnormalities, prescription of drugs, or hormonal therapy. In addition, doctors often focus on treating medical conditions that result in a lack of menstruation.

What is primary and secondary amenorrhea? What's the Difference?

Amenorrhea is a permanent or temporary absence of menstruation. Doctors divide amenorrhea into primary and secondary. In the first case, the girls do not start menstruation when they reach 16 years old, in the second case, for women who have previously regularly observed their periods, they are absent for three consecutive menstrual cycles or for a six-month period.

Many internal factors can influence the menstrual cycles, for example hormonal changes, stresses, diseases, as well as environmental factors. The absence of a single period rarely indicates a woman has serious health problems or medical conditions, but amenorrhea, observed over a longer period, often indicates a disease or chronic condition.

What are the causes of amenorrhea?

A normal menstrual cycle occurs amid changes in the level of hormones secreted by the ovaries. The ovaries respond to hormonal signals from the pituitary gland located in the brain. In turn, the pituitary gland is controlled by hormones that are produced by the hypothalamus of the brain. Disorders affecting any of the listed parts of the mechanism for providing menstrual cycles can lead to amenorrhea.

Sometimes the same causes can cause both primary and secondary amenorrhea. For example, problems with the hypothalamus, anorexia, or excessive physical activity can play a significant role in the development of amenorrhea, regardless of the woman's age and the presence of her menstrual experience.

Primary amenorrhea

Primary amenorrhea usually results from genetic or anatomical conditions in young women who, before the age of 16, have never observed menstruation and are not pregnant. Many genetic abnormalities that are accompanied by amenorrhea are caused by the fact that some or all organs of the woman’s reproductive system either did not form during intrauterine development or do not function correctly. Diseases of the pituitary and hypothalamus (areas of the brain responsible for the production of hormones) can also cause primary amenorrhea, since they have a significant effect on the regulation of hormones secreted by the ovaries.

Gonadal dysgenesis - a condition in which normal ovarian function is prematurely impaired. This is one of the most common causes of primary amenorrhea in young women.

Another genetic reason is Turner syndrome. In this condition, a woman is deprived of one of two X-chromosomes (or part of it), which should be present in a healthy female body. With Turner syndrome, the place of the ovaries is occupied by scar tissue, and estrogen is produced in a minimal amount, resulting in amenorrhea. The development of genitals and sexual characteristics is also impaired.

Other conditions that can cause primary amenorrhea include the following.

  • Tolerance to androgens. In this condition, the individual has XY chromosomes, but external male characteristics do not develop due to an insufficient reaction to testosterone.
  • Congenital adrenal hyperplasia.
  • Polycystic ovary syndrome.

Secondary amenorrhea

Pregnancy is the obvious and most common cause of secondary amenorrhea. However, there are many other conditions that cause the cessation of menstrual cycles. These include problems with the ovaries, uterus, hypothalamus, and pituitary gland.

Hypothalamic amenorrhea is associated with a disorder of hormones produced by the hypothalamus in the brain. These hormones act on the pituitary gland, which in turn stimulates the ovaries to produce hormones that ensure the flow of menstrual cycles. Several conditions may affect the hypothalamus, for example:

  • excessive weight loss
  • emotional and physical stress,
  • excessive physical activity
  • severe illnesses.

Medical conditions that can cause secondary amenorrhea include the following:

  • tumors or diseases of the pituitary gland that lead to an increased level of the hormone prolactin (involved in the production of milk),
  • hypothyroidism
  • increased levels of androgens (male hormones) caused by external sources or disorders that provoke the body to produce too high levels of male hormones,
  • impaired ovarian function (ovarian exhaustion syndrome or early menopause),
  • polycystic ovary syndrome,
  • Asherman's syndrome - uterine pathology, which is characterized by the formation of adhesions of the lining layer of the inner wall of the uterus (endometrium). Adhesions occur after gynecological procedures in the uterine cavity (such as expansion and curettage) performed to control postpartum hemorrhage or infections.

Amenorrhea associated with the use of hormonal contraceptives

Not later than three months after the cessation of taking birth control pills, menstruation should return to the woman. Previously, doctors believed that after using oral contraceptives, a woman has an increased risk of developing amenorrhea, but later this theory was disproved. If a woman has not returned her menstruation after three months after giving up birth control pills, she should go to the doctor to find the causes of secondary amenorrhea.

What are the symptoms of amenorrhea?

Primary amenorrhea occurs if a girl does not begin menstrual cycles at the age of 16 years.

With secondary amenorrhea in a woman who previously observed regular menstrual cycles and is not in a state of pregnancy, three consecutive cycles are absent or menstruation does not occur for at least six months.

In both cases, girls and women may experience other symptoms, which vary widely depending on the underlying cause of amenorrhea. For example, symptoms of hormonal imbalance or excess male sex hormones can include irregular periods, unwanted hair growth, a low voice, and blackheads. Elevated prolactin levels can lead to galactorrhea, that is, to the release of milk from the nipples, not associated with feeding the baby.

When should amenorrhea seek medical attention?

In any case, amenorrhea, a visit to the doctor will be a useful step. The long-term absence of menstruation, which is not associated with pregnancy or menopause (the time when a woman at the end of the reproductive life cycle does not have menstruation for 12 consecutive months and there are no other physiological and biological reasons for this) should be evaluated by a specialist in order to exclude other dangerous conditions that can lead to amenorrhea.

How is amenorrhea diagnosed?

When diagnosing amenorrhea, the doctor will study and supplement the patient’s medical history in detail, entering data on amenorrhea, as well as on the conditions that can cause it. In addition, the doctor will probably want to have a gynecological examination.

Depending on the results obtained by studying the medical history and gynecological examination, other diagnostic procedures may be offered to the woman. For example, blood tests can show hormones of the ovaries, pituitary gland, and thyroid gland. With such analyzes, the levels of prolactin, follicle-stimulating hormone (FSH), estrogen, thyrotropin, dehydroepiandrosterone sulfate and testosterone can be measured. In some cases, the first step in the diagnosis will be a pregnancy test.

Visual diagnostic procedures, such as ultrasound, X-ray, computed tomography, or magnetic resonance imaging, can also be recommended to identify the causes of amenorrhea.

How is amenorrhea treated?

The treatment of primary and secondary amenorrhea depends on the specific cause. Therapy is usually aimed at reducing the symptoms of hormonal imbalance, causing menstruation, preventing complications and eliminating infertility. Not in all cases are all of the above goals achieved.

If amenorrhea is caused by genetic or anatomical abnormalities (usually primary amenorrhea), then the doctor may recommend surgical intervention.

Hypothalamic amenorrhea associated with weight loss, excessive exercise, physical illness, or emotional stress is usually resolved by treating the underlying cause. For example, weight gain and reduced exercise intensity often help return menstruation to women who have amenorrhea associated with excessive weight loss or excessive physical activity. In some cases, consulting a nutritionist may benefit a woman.

In those situations where the ovaries ceased to function prematurely, the doctor may recommend hormone replacement therapy that can alleviate the unpleasant symptoms of a decrease in estrogen levels and prevent the development of related complications, such as osteoporosis.

Such treatment may include taking birth control pills for women who do not want to become pregnant, or taking alternative drugs containing synthetic estrogen and progesterone. Despite the fact that hormone replacement therapy after menopause is associated with certain health risks in older women, young patients with premature ovarian failure can benefit from such treatment in the prevention of osteoporosis.

For women with PCOS (polycystic ovary syndrome), it may be helpful to reduce the activity of male sex hormones or androgens.

Drugs that are part of the dopamine agonist group, for example, bromocriptine (parlodel), can reduce elevated levels of prolactin, which can cause a prolonged absence of menstruation.

For some types of amenorrhea in women who want to become pregnant, doctors can use assisted reproductive technologies along with gonadotropins, that is, drugs that stimulate the maturation of follicles in the ovaries.

Note!
Despite the fact that many companies are currently actively promoting herbal remedies for the treatment of amenorrhea, the benefits of none of them have not yet been scientifically proven. Moreover, the quality of such drugs is not controlled by state authorities, and sometimes treatment with plants and herbs causes serious side effects and in rare cases even leads to deaths. That is why women who want to try this type of alternative treatment should first consult with their doctor.

What complications is amenorrhea associated with?

Infertility is the most serious complication of amenorrhea for women who want to become pregnant. Osteopenia (decrease in bone density) or osteoporosis are complications that are associated with a low estrogen content in the body, which can also lead to the absence of menstruation. Other potential complications of amenorrhea depend on the underlying causes.

Can amenorrhea be prevented?

Amenorrhea is not a disease, but a symptom. Therefore, the prevention of amenorrhea is the prevention of the condition that underlies amenorrhea. For example, amenorrhea due to genetic or congenital conditions cannot be prevented. But amenorrhea caused by excessive weight loss or intense physical activity can be prevented.

What are the prospects for treating amenorrhea?

The prospects for treating amenorrhea vary widely and depend on its causes. Hypothalamic amenorrhea, which causes stress, physical activity, or weight loss, usually resolves quite easily. Medications and hormone therapy can play a significant role in eliminating unpleasant side effects and preventing complications of amenorrhea in many women.

How often

The prevalence of primary amenorrhea varies according to various sources from 1.5 to 2%. Moreover, the disease, together with its secondary form, occupies 10-15% in the structure of diseases associated with impaired reproduction. This means that in 10-15% of girls and women who turn to doctors because of the inability to conceive and bear a child, they reveal the absence of menstruation for six months or more, or the complete absence of menstruation from 16 years.

Types of Primary Amenorrhea

There are two classifications of primary amenorrhea. First of all, they distinguish:

  • the true form of pathology in which there is no functional connection between the hypothalamus, pituitary, ovaries and uterus and, as a result, there are no cyclical changes in these organs, sex hormones are not enough for cyclical changes in the endometrium.
  • a false form of the disease in which there is a functional connection between the organs and there are cyclic changes, however, blood and tearing off the endometrium for some reason cannot go outside, for example, due to malformations of the cervix, vagina, hymen. These conditions require the intervention of a doctor and respond well to treatment.

The second classification divides primary amenorrhea into:

  • pathology with delayed sexual development - in this case, a delay in the development of secondary sexual characteristics is detected,
  • disease without signs of delayed sexual development - there is no violation of the development of secondary sexual characteristics in this case.

Amenorrhea with delayed sexual development

The delay in sexual development is manifested by the lack of growth of the mammary glands and body hair of a female type at the age of more than 14 years. A girl constitutionally may not correspond to the height and weight laid down for her peers. When taking bone images, the lag of bone age to the true one is also revealed.

The main causes of primary amenorrhea in this case are two:

Gonad malformations

The cause of malformations with no ovaries is genetic abnormalities. This congenital pathology is called gonad dysgenesis syndrome.

  • gonadal dysgenesis is a malformation in which a girl does not have hormone-active tissue in her ovaries, which is why estrogen in the body is insufficient or completely absent. When researching a chromosome set in a genetic laboratory, various chromosomal abnormalities are determined. Instead of ovarian tissue in the body by ultrasound or laparoscopy, connective tissue cords can be seen. They do not secrete hormones and there is no stock of eggs in them. A particular and classic case of gonadal dysgenesis is the Shershevsky-Turner chromosome syndrome, in which there is no second X chromosome,
  • testicular feminization syndrome is a malformation in which the girl has a male genotype (XY), but her appearance is typically female.

Disorders in the hypothalamic-pituitary system

A distinctive feature of this type of amenorrhea is a decrease in the level of hormones (gonadotropins) produced in the brain. This can be detected by a blood test for FSH and LH.

There are no gonadotropins - the ovaries are not stimulated - there is no secretion of sex hormones in the ovaries - delayed sexual development - lack of menstruation.

Violations in the pituitary-hypothalamus system are divided into 2 groups:

  • functional disorders, they can be the result of malnutrition, frequent stress, infectious diseases, intoxication, many chronic diseases,
  • organic disorders - the presence of congenital anomalies in the structure of the hypothalamic-pituitary system or tumors, because of which the complex of organs is no longer able to perform its functions. The consequences of meningitis or encephalitis can also be the cause of such disorders.

Amenorrhea without delayed sexual development

The cause of primary amenorrhea without delayed sexual development is various malformations of the genital organs. For example, there may be a complete absence of the uterus (aplasia of the uterus) or ginatresia - the absence of natural holes in the hymen.

There are also malformations when the ovaries are and secrete a sufficient amount of sex hormones, but the girl does not have a uterus or a vagina is not formed.

The absence of a uterus in the girl’s body is called Meyer-Rokitansky-Kustner syndrome. The ovaries in this disease secrete sex hormones in the usual way, and outwardly the girl develops normally, in accordance with age. At the age of 16 years or more, parents usually bring the girl to the reception, worried about her lack of menstruation. During the examination, the absence of the uterus is revealed, the vagina is usually short, sometimes absent, and in this case, in order for the girl to have a normal sex life, plastic surgery is required.

When to go to the doctor

Features in the absence of menstruation in young girls

When the mother and the child observing the doctor should be concerned about the absence of menstruation and suggest the presence of the disease:

  • The girl is 16 years old, and the periods did not come,
  • The girl is 14 years old, but there are no signs of puberty (breast growth, pubic hair, armpits),
  • It has been 3 years since the growth of the mammary glands and the appearance of sexual hair growth, but there are no menstruation,
    A noticeable lag in growth and weight indicators from the norm at this age and from peers.
  • After the timely appearance of signs of puberty at the age of the onset of menstruation (11-16 years), the girl did not experience cyclic spotting from the genital tract, but cyclic pain in the lower abdomen.

The pains can be bursting, with an increase in temperature, with a feeling of a feeling of pressure on the rectum, with difficulty urinating. Cyclic pain syndrome can be caused by the monthly appearance of menstruation, the accumulation of blood in the uterus and fallopian tubes and the inability to pour out with malformations of the vagina, cervix and hymen. After the diagnosis of this condition, it is successfully amenable to surgical treatment.

Depending on the cause of the violation in the menstrual cycle, the following can also be observed:

  • virilization of the external genitalia (unnatural enlargement of the clitoris, for example),
  • increased growth or active growth of individual limbs (with an excess of growth hormone),
  • neurological symptoms (migraines, headaches, visual impairment) - with tumors,
  • violation of hair growth (complete absence of hair in the pubic and axillary regions),
  • pain in the lower abdomen during menstruation (in the absence of holes in the hymen).

Shereshevsky-Turner syndrome is characterized by a number of symptoms. Among them:

  • low birth weight
  • the presence of swelling of the hands and feet of lymphatic origin,
  • the presence of pterygoid folds in the neck,
  • high upper sky (Gothic),
  • large distance between the nipples,
  • a sharp decrease in estrogen and testosterone levels, increased levels of FSH and LH.

Survey

In the diagnosis, great importance is given to collecting an anamnesis, as well as examining a patient.

Inspection of the gynecologist. Just on examination, you can see signs of delayed sexual development and malformations of the vagina and hymen.

Vaginoscopy: examination of the vagina to the full depth and the cervix through a physiological hole in the hymen. Performed with suspected genital malformations. The procedure is painless for the girl, does not damage the natural hymen, can be performed on an outpatient basis. Inspection is carried out using a vaginoscope: a thin tube with a video camera.

Mandatory survey package:

  • assessment of hormonal levels (level of testosterone, estrogen, LH and FSH),
  • thyroid hormones, prolactin, cortisol, etc. are also being investigated.
  • hormonal tests (with estrogens, ACTH, progesterone, dexamethasone, etc.) - consist of maintaining the hormone in the body for several days and monitoring the body's reaction (menstrual bleeding will start or not),
  • X-ray, CT and MRI scans of the skull to determine the state of the pituitary gland, identify pathologies of the development of the Turkish saddle, exclude tumor processes,
  • Laparoscopy allows you to clarify the diagnosis in the presence of malformations and dysgenesis of gonads,
  • An ultrasound examination of the pelvic organs can help identify the absence of the uterus, blood accumulation in the uterus or in the upper vagina with malformations of the cervix or lower parts of the vagina, the absence of ovaries with follicles and their replacement with connective tissue cords with dysgenesis of gonads, a decrease in the size of the uterus and ovaries ("Baby" uterus).,
  • MRI of the small pelvis is performed for differential diagnosis between various forms of malformations of the uterus, and also helps to clarify the presence or absence of genital organs in the small pelvis.
  • Examination of the genetics and study of the chromosome set in the girl will reveal the genetic cause of amenorrhea. Determination of karyotype and sex chromatin (used for reliable diagnosis of Shereshevsky-Turner syndrome),
  • An examination by an oculist and assessment of visual fields (perimetry) is performed to exclude a pituitary tumor and intracranial hypertension.

The disease is treated by an endocrinologist-gynecologist or gynecologist with the obligatory consultation of an endocrinologist.

When abnormalities in the pituitary-hypothalamic system and delayed sexual development are detected, a test with an analog of gonadotropin-releasing hormone (GnRH) is used. If the girl’s body has a positive response to a test with an analog of GnRH, then the treatment may be non-hormonal. They begin with the use of neurotropic and vitamin complexes in order to improve the connection between the cerebral cortex, the structures of the hypothalamus and pituitary gland. In some cases (especially if the cause of amenorrhea is a nervous breakdown), this has an effect. In the absence of a reaction to a sample with an analog of GnRH, hormonal drugs are immediately prescribed with a replacement purpose.

If a pituitary tumor is detected, it is removed. A girl with the introduction of hormones from the outside will catch up with peers in development and the menstrual cycle will improve. The prognosis for childbearing is favorable; it is possible to use IVF.

When determining genetic chromosomal abnormalities and the absence of ovaries in the girl’s body (gonad dysgenesis), hormone replacement therapy should be started immediately so that the girl externally develops in accordance with age. If at the same time the extra Y-chromosome is present in the girl’s chromosome set, then before starting HRT, it is necessary to remove the connective tissue cords replacing the ovaries. This is done in order to prevent the growth of malignant tumors from connective tissue cords, often developing with such a chromosome set.

With genetic chromosomal abnormalities and the absence of normal ovaries in a girl, hormone replacement therapy is indicated for a long time, until the age of middle menopause. Of course, the girl herself will not be able to give birth and give birth.

Malformations of the vagina are successfully operated on. Girls menstruate, live sexually and conceive a child after plastic surgery. When the hymen is infected and there is a septum in the vagina, they are dissected.

Plastic surgery to create an artificial vagina in its absence requires hospitalization in central clinics and a highly qualified operating gynecologist.

In the absence of the uterus (Rokytansky-Küstner syndrome), sometimes plastic surgery to lengthen the vagina is also necessary for a full sexual life. The ovaries in this situation work in accordance with age, hormone replacement therapy is not indicated. Plastic surgery to create an artificial uterus is currently not used. If you want to have a baby, the women fertilize the egg with IVF, and the surrogate mother carries the pregnancy.

Possible complications

Primary amenorrhea, the presence of which is ignored for a long time, can lead to:

  • infertility (reproductive dysfunction is observed in most cases, is difficult or impossible to correct at all, often the only way out is IVF or surrogacy),
  • osteoporosis - a condition in which destructive processes in the bone tissue prevail over the recovery processes and, as a result, the bones lose their strength,
  • atherosclerosis - the deposition of lipid plaques on the walls of blood vessels, which lead to a narrowing of the lumen of the vessel and, as a result, impaired blood flow,
  • obesity - a violation of the hormonal balance in the body often leads to weight gain, in which diets are ineffective.

Prognosis and prevention

Due to the fact that primary amenorrhea is a consequence of mainly congenital disorders, the means for its effective prevention have not yet been developed. Much depends on the initial state of health of the mother at the time of pregnancy, her lifestyle. The prognosis for timely treatment in most cases is favorable. A woman may not be able to conceive or bear a child on her own, but the symptoms of primary amenorrhea will not affect her quality of life.

When is amenorrhea the norm?

Menstruation begins at the age of 12-16 years, until this moment its absence is normal. The reproductive system of the girl is at rest.

During menopause, the absence of menstruation is also a normal variant. Menopause comes in the period of 49-52 years. These are average values. You should focus on the age at which menopause has occurred in women in the family.

Breastfeeding and amenorrhea are two normal phenomena that should be combined with each other. When a woman breast-feeds a baby, hormones are produced that interfere with the maturation of the egg. A similar situation is observed during pregnancy. The ovum fulfilled its main purpose - the woman conceived a child. Until his birth, other eggs are not needed, so they are at rest, which means that menstruation does not occur.

Degrees of amenorrhea

There are 3 degrees of amenorrhea:

Mild amenorrhea. Menstruation is absent throughout the year. During this period, choosing the right treatment will not be difficult.

The average degree of amenorrhea. Menstruation does not occur within 1-3 years.

Severe amenorrhea. Menstruation is absent for more than 3 years.

Amenorrhea can be primary and secondary. It is very important to determine which disorder develops in the patient, since the characteristics of treatment depend on this.

Intrauterine pathology

Many operations performed on the uterus negatively affect the health status of women. Dangerous in this regard, intrauterine abortion, curettage, hysteroscopy, removal of polyps.

Such manipulations can lead to significant thinning of the uterine wall, which affects the functioning of the organ. During the natural cycle, the endometrium cannot fully increase, so when the time comes for the next menstruation, there is simply nothing to be rejected. Such a violation does not develop on its own. Menstruation becomes less abundant over time, after which they cease to go at all. If a woman simultaneously has inflammation of the internal genital organs, then the pathology acquires a severe course.

Sometimes after surgery, the cervical canal is infected. You can cope with the pathology in an operational way.

Abortions or other traumatic procedures may result in adhesions. They grow in the uterus, filling it from the inside.

All these complications lead to the fact that it will be difficult and sometimes impossible for a woman to become pregnant.

Treatment is reduced to hysteroscopy, cutting adhesions, the introduction of special drugs that prevent them from overgrowing. Hyaluronic acid preparations may be used to cope with the disorder.

Disorders in the functioning of the hypothalamic-pituitary system

Amenorrhea associated with low body weight. This amenorrhea most often occurs in adolescent girls. Many of them, in pursuit of imaginary beauty, begin to lose weight very much. This leads to the fact that the fat layer completely disappears. The body perceives menstruation as a loss of blood and energy, therefore it stops producing hormones so that the follicles continue to ripen.

To cope with the problem, you need to start eating right and gain body weight. Be sure to prescribe vitamins for the girl.

Amenorrhea of ​​psychogenic origin. If a girl experiences a severe emotional shock, then her period may stop. So, during the war, women who sent their husbands and sons to the front did not often have menstruation.

To cope with the problem, you need to minimize the effect of stress on the body. Hormones are most often not used in such situations. If stress persists for a long time, you should consult a specialist, since the absence of menstruation can cause early menopause.

Ovarian Hyperbrake Syndrome

OHSS develops after a woman has been taking hormonal drugs for a long time, including:

Agonists gonad-releasing hormones (Goserelin, Buserelin).

Most often, after some time after the drug is discontinued, menstruation returns to normal on its own. If menstruation does not occur 2-3 months after the completion of hormonal medication, then you need to see a doctor. Moreover, the lower the woman’s body weight, the higher the likelihood of developing amenorrhea.

Patients will be assigned an analysis to determine the level of prolactin. If there are no failures, then you can use citrate to restore menstruation of clomiphene. This drug stimulates ovulation. It is used for 1-4 months. When the situation stabilizes, the drug is canceled.

Bromocriptine is prescribed to patients with high prolactin levels. The drug is taken until the hormone levels drop to 5430 mIe and lower.

Violations of the hypothalamic-pituitary system of organic nature

Delayed menstruation due to a tumor growing in the brain can happen, but it does not happen often. Neoplasms increasing in size put pressure on the pituitary and hypothalamus, which entails a whole cascade of reactions: hormonal imbalance occurs, menstruation ceases. You can cope with the disease only by surgery. After removal of the tumor, menstruation resumes. This happens after six months or a year.

Sheehan's syndrome is a vascular spasm, or hemorrhage in the pituitary gland. Such a violation most often occurs in women after childbirth, when the pregnancy itself was complicated by preeclampsia. Nursing mothers may not notice the absence of menstruation, since amenorrhea is covered by lactation. However, after refusal from breastfeeding, menstruation does not begin. After 2 months of their absence, you must contact a specialist.

If the doctor reveals Sheehan's syndrome, he will prescribe the patient Metipred or Prednisolone, thyroid hormones, or hormone replacement therapy with Angelic, Divina, Femoston. Self-medication should not be taken, since it will not be possible to restore the cycle without understanding the cause of amenorrhea, but gaining extra weight is quite realistic.

Empty Turkish Saddle Syndrome

The Turkish saddle is located in the brain next to the pituitary gland. It empties when the pituitary gland is under pressure for a long time and atrophies. Frequent pregnancies or difficult labor can provoke a similar situation. The treatment is carried out according to a similar scheme as the treatment of Sheehan syndrome.

Ovarian Amenorrhea

Sometimes the cause of amenorrhea is a malfunction in the ovaries. At the same time, the hormonal system as a whole will function properly.

In resistant ovary syndrome, these organs of the reproductive system simply stop responding to stimulation with sex hormones. The disorder develops in women under 36 years of age. Often a similar situation can be traced to the grandmother, mother, daughter, that is, is of a family nature. You can cope with the problem only with the use of hormonal drugs of combined action. A woman will not be able to give birth on her own. IVF using a donor egg is required.

Syndrome of premature ovarian exhaustion leads to the fact that the eggs cease to be produced and the patient develops menopause. And this can happen at an early age (up to 43 years). This syndrome can cause severe infections (flu, rubella, mumps, measles), or treatment for cancerous tumors.

Other types of amenorrhea

False amenorrhea. This type can be attributed, for example, when the menstruation process proceeds normally, but, for one reason or another, the blood does not leave the body. This can be, for example, some kind of congenital pathology, as well as deviations acquired in the process of life. A rather striking example of this is the overgrowth of the hymen or vagina. Here we are talking about acquired mechanical obstacles. Some deviations can only be diagnosed using ultrasound, in any case, the word "mechanical" is here defining.

True amenorrhea - lack of a monthly cycle in girls. Here the absence of the menstrual cycle is manifested, but without visible hormonal signs and changes in the reproductive system. A woman's ability to get pregnant is completely lost.

Physiological amenorrhea called the absence of a cycle due to various age deviations. Deviations can occur both during the growing up of the body, and at its end, the disease can manifest itself and end by itself. Here we are not talking about the disease, since this is completely normal. For example, some women lose their ability to cycle during breastfeeding. Or after pregnancy, while the body is recovering.

Pathological amenorrhea - This is the most serious form of amenorrhea. Here we are talking about a violation in the body. In this case, the reproductive ability may be completely lost. Most often this happens in those girls who have never had a monthly cycle, that is, young or, conversely, middle-aged women. Violations are both functional and organic in nature.

Diagnosis of amenorrhea

Diagnosis of amenorrhea begins with a history and examination of the patient. The doctor will definitely find out the state of women's health of the mother. This will allow you to trace the family history of the disease. It is important to clarify exactly when the woman's period began, whether she was exposed to radiation, whether she was overweight. If the patient suffers from other chronic diseases (cardiovascular pathologies, obesity, joint diseases), she should inform the doctor about this.

The doctor draws attention to the type of physique of the woman, to hair growth, the degree of development of the mammary glands and other characteristics of sexual health.

The next stage of diagnosis is the examination of the patient on a gynecological chair. The doctor assesses the condition of the pelvis, external genitalia. If the girl is a virgin, then inspection using mirrors is not practiced.

Ultrasound of the genital organs and mammary gland gives information about the size of the organs, about their functioning, about the maturation of the ovarian follicles. The study reveals cysts and tumor neoplasms.

Be sure to take blood for hormones. The level of thyroid hormones (T4 and TSH), as well as sex hormones (FSH, LH, DHEA, AMH, prolactin, testosterone, etc.) are determined.

A woman may need to consult narrow specialists: oncologist, genetics, endocrinologist, neurologist, neurosurgeon, nutritionist, pediatrician. Ultrasound of the adrenal glands, thyroid gland, MRI of the brain, X-ray of the skull is performed. All these studies in the complex are rarely prescribed. The doctor selects certain diagnostic methods that are needed to confirm the diagnosis and determine the cause of amenorrhea.

Amenorrhea treatment

For the treatment of amenorrhea, drugs such as:

Drugs containing estrogens: Folliculin, Estrogel, Divigel, etc. They are prescribed in the situation when amenorrhea develops against a background of estrogen deficiency.

Progestogens: Utrozhestan, Prajisan, Dufaston, Norethistron. They are prescribed for deficiency of hormones of the second phase of the cycle, or progestogens.

Antiestrogens: Clomiphene Citart. This medication is used to stimulate ovulation.

Combined hormones: Femoston, Angelique, Divina. They are prescribed to restore ovarian function.

Thyroid hormones: L-thyroxine, Eutiroks.

Glucocorticosteroids: Prednisone, Metipred. They are prescribed to restore adrenal function.

Bromocriptine (Parlodel). This medication lowers prolactin levels.

The operation is prescribed for gynecological pathologies, as well as for damage to the brain by tumor neoplasms.

Amenorrhea is a serious disorder in the body that should not be ignored. If menstruation is not available for a woman of childbearing age, then she needs to contact a doctor and receive treatment.

Education: The diploma "Obstetrics and Gynecology" was obtained at the Russian State Medical University of the Federal Agency for Health and Social Development (2010). In 2013, graduate school at NIMU im. N.I. Pirogova.

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Watch the video: What is amenorrhoea? (January 2020).