Amenorrhea is a condition in which for six months or more there are no monthly bleeding associated with rejection of the inner layer of the endometrium - the endometrium. Amenorrhea is not an independent pathology, but one of the symptoms of abnormalities in the body.
The exception is the so-called physiological amenorrhea, in which menstruation is absent as a result of the passage of the female body certain stages in development. It happens before puberty, during the period of childbearing and breastfeeding, and at the onset of menopause due to the extinction of sexual function.
In other cases, amenorrhea is pathological.
What it is?
Amenorrhea is the absence of menstruation over several cycles in women of childbearing age, or the absence of menarche (first menstruation) in girls over 16 years of age.
Amenorrhea is not a separate disease. This is only a symptom that indicates that physiological changes occur in a woman's body or serious diseases develop. The task of doctors in such situations is to identify what exactly caused the menstrual cycle disorder and choose the right treatment tactics.
Causes of Primary Aminorrhea
Primary amenorrhea may be due to:
- gonadal dysgenesis (hypoplasia of the gonads),
- Shereshevsky-Turner syndrome (leads to the development of amenorrhea in 1 out of 2500 newborn girls),
- congenital hypopituitarism,
- congenital abnormalities of the reproductive system (for example, the vaginal canal is blocked),
- tumors of the central nervous system, in particular, the hypothalamic-pituitary region,
- psycho-emotional stress
- malnutrition of a teenager,
- excessive exercise.
Due to certain reasons in the woman's body, the processes of synthesis and release of female sex hormones into the blood are disrupted, and therefore the menstrual cycle is interrupted up to the absolute absence of menstruation.
Causes of secondary amenorrhea
Temporary Pathological amenorrhea may be associated with various common diseases of a woman:
- Amenorrhea can occur after artificial abortion, after cauterization of the uterine mucosa with iodine and other means.
- Metabolic disorders and diseases with lesions of the endocrine glands (thyroid diseases - hypothyroidism, thyrotoxicosis, adrenal glands, obesity, diabetes, acromegaly, etc.),
- When a pituitary tumor - prolactinoma (benign tumor, leading to an increase in the hormone prolactin in the blood),
- In case of poisoning of the body with lead, phosphorus, nicotine, morphine, alcohol.
- With polycystic ovary syndrome, ovarian depletion syndrome, various ovarian tumors,
- In severe infectious diseases (typhoid, tuberculosis, sepsis, malaria, etc.),
- General exhaustion, dramatic weight loss,
- Blood diseases (chlorosis),
- In some cases, temporary amenorrhea occurs with excessive fatigue - physical and mental (for example, in students during examinations), on the basis of nervous and mental experiences, severe stress (fear, fear). These include amenorrhea "wartime".
These diseases have a depressant effect on the activity of the ovaries, in which the process of maturation of the eggs stops, which inhibits the onset of menstruation.
The main symptom of amenorrhea is the absence of menstruation. However, there are a number of associated symptoms:
- lack of menstruation,
- loss of ability to become pregnant
- autonomic dysfunction (excessive sweating, rapid heartbeat),
- obesity (about 40% of patients),
- signs of mucification, dysfunction of the thyroid gland or adrenal glands,
- signs of excess androgens - male sex hormones (increased oily skin, acne, excessive hair growth).
Treatment of primary amenorrhea
The basic principles of treatment in this case are focused on correcting or completely eliminating the factors that provoked this form of amenorrhea. Thus, Turner's syndrome (a pathology characterized by the underdevelopment of the sex glands against the background of abnormal development of sex chromosomes) determines the need for lifelong replacement therapy with the use of hormonal drugs.
Delayed reproductive and physical development requires the appointment of a diet to girls, contributing to the increase in fat and muscle mass in conjunction with hormonal treatment, due to which it is possible to stimulate menstrual function.
With the relevance of anatomical obstacles, against the background of which amenorrhea develops, they are removed surgically. Thus, such conditions are created under which adequate flow of menstrual blood from the uterus to the outside, through the genital tract, will be ensured. Increased emotional instability lies in the implementation of treatment measures aimed at strengthening the general state of the nervous system of patients.
Passion for diets at a young age is particularly detrimental to health. Thus, when the diet is limited, the body loses the fats, proteins, minerals and vitamins it needs, due to which development slows down in general, there is a sharp weight loss, anorexia develops. Naturally, all this affects, among other areas of influence, and on sexual development, which creates the basis for the development of amenorrhea. Separately, it should be noted and strength sports, which also adversely affect women's health (bodybuilding, martial arts, weightlifting, etc.), because they must be avoided.
Treatment of secondary amenorrhea
Comprehensive treatment of recurrent amenorrhea is aimed at eliminating the factors that caused it.
Amenorrhea, associated with a sharp decrease in weight or physical exertion, is a consequence of a poor lifestyle and requires its change. A critical indicator for the normal course of the menstrual cycle in an adult woman is the loss of 10 or more kilograms of weight, as well as body weight less than 50 kg. Until complete normalization of the menstrual function, progestogen oral contraceptives are usually prescribed that do not contain estrogenic components. Often, secondary amenorrhea is eliminated without hormonal therapy, subject to reasonable physical exertion, rational diet, work and rest, normalization of the psycho-emotional background.
Secondary amenorrhea that develops in polycystic ovary syndrome requires the treatment of a background disease. In order to normalize the ovulatory cycle, polycystosis of the ovaries is prescribed hormonal contraceptives or laparoscopic diathermocoagulation of the organ tissue is performed (if indicated).
Hyperprolactinemia, as a factor in the development of amenorrhea, is eliminated by taking drugs - dopamine agonists that lower the level of prolactin. The effectiveness of treatment is determined by the control of the basal temperature, the increase of which indicates the completion of ovulation. With tumor lesions of the pituitary gland shown neurosurgical intervention. Secondary amenorrhea due to premature menopause is corrected with long-term hormone replacement therapy.
ART and in vitro fertilization, which is successfully applied by modern gynecology, allows women to carry out pregnancy with premature menopause and secondary amenorrhea that cannot be treated. In such cases, a donor egg cell or donor embryo is used for artificial insemination (using ICSI, PIXY or IMSI) methods. Then, the embryos are transplanted into the uterus of the expectant mother.
The sudden cessation of menstruation in women of childbearing age (secondary amenorrhea) is a signal of distress and malfunction in the body requiring attention. Some of them are easily remedied by changes in lifestyle, others need qualified medical care. The danger of amenorrhea is that it is always associated with the female factor of infertility.
To avoid the development of primary amenorrhea, girls should avoid stress, properly - fully, rationally, regularly - eat, avoid all sorts of diets that disrupt the normal flow of nutrients into the body. Their deficiency will slow down the development of a growing organism and will become one of the risk factors for amenorrhea. In addition, girls are not recommended to engage in power sports.
Preventing the emergence of secondary amenorrhea will also help correct lifestyle in combination with a balanced diet, as well as the attentive attitude of women to their health - timely diagnosis and adequate treatment of diseases that could cause menstrual disorders.
Questions and answers
1) I started my period, but stopped the next day, after that there was already no month. What could it be?
- Take a pregnancy test, this may indicate a threat of miscarriage in the early stages or ovarian dysfunction. In any case, you must go to the gynecologist.
2) I have stopped my period at the age of 14 after a dramatic weight loss. Gained weight, monthly appeared again. Now I want to get pregnant, but it does not work. Could this be a consequence of amenorrhea?
- Every woman has a chance to become infertile, it is not necessarily associated with amenorrhea in the past. Another thing is a sharp causeless loss - it may indicate the presence of endocrine diseases, which do not allow you to get pregnant. You need to consult a gynecologist if you can’t get pregnant for one year of regular unprotected sex.
3) How long does amenorrhea last after giving birth?
- It depends on whether you are breastfeeding. In non-nursing women, the menstrual cycle can recover in 6-8 months, and in nursing in a few months or even in a year. This is all a variant of the norm.
4) I have polycystic ovary syndrome. I have been unsuccessfully treated for infertility for several years with hormones, but no effect, what to do?
- Most likely, you are shown surgical stimulation of ovulation, or you need to resort to artificial insemination. In any case, the treatment tactic should be determined by your doctor.
5) I am 38 years old, there is no monthly period. Signs of menopause do not bother, I do not want to give birth. Do I need to be treated?
- It is necessary to be treated. Early menopause can lead to serious illnesses.
6) I am 16 years old, but there is still no menstruation. Can I have sex?
- You can, but you also need to visit a gynecologist and find out the reason for the absence of menstruation.
7) Is it possible to get pregnant during lactation if there is no monthly?
- Lactational amenorrhea is an unreliable method of contraception, so pregnancy is possible even if you do not have menstruation.
8) Can there be amenorrhea from long-term use of hormonal contraceptives?
- Yes maybe. This is a rare side effect of hormonal contraceptives when ovarian hyper-inhibition syndrome develops. It is necessary to stop taking hormones, the menstrual function will recover on its own in a few months after the cancellation.
What is amenorrhea
According to the ICD-10 classification (the international classification of diseases from 2010 revision), amenorrhea is coded as N 91. Pathology is established in two cases:
- in the absence of menstruation in a girl of 16-18 years old,
- with delayed menstruation for six months or more.
The harmonious work of the brain structures (pituitary, hypothalamus), endocrine organs, as well as the uterus and ovaries provides cyclical changes in the body and menstruation. Malfunctioning or mechanical obstruction leads to amenorrhea.
Depending on the cause and mechanism of development, there are varieties.
- True amenorrhea. Cyclic hormone secretion is impaired, so the endometrium does not mature and there is no menstruation. It happens with many diseases. Depending on the location of the problem, suprahypothalamic, pituitary-hypothalamic amenorrhea, ovarian (sometimes called the egg), uterine amenorrhea are isolated.
- False amenorrhea. If there is a mechanical obstruction at the level of the cavity, cervix and vagina, there is no menstruation due to the fact that the discharge cannot exit the genital organs.
- Physiological. This is a temporary or permanent absence of menstruation, which is not accompanied by pathology. It happens during pregnancy, breastfeeding, during menopause and puberty.
- Primary. If a girl has never had a month. This is the developmental pathology of adolescents.
- Secondary. If a woman had at least one menstruation.
When to suspect
The main symptom of amenorrhea is the absence of any menstrual discharge. This is the main criterion, all other signs vary depending on the cause.
Amenorrhea is established in dvushki in the event that it has reached 16 years and she has never had menstruation. This is the primary form. If the monthly were at least once, for the diagnosis of their absence for six months or more.
Often the pathology is combined with other symptoms:
- additional signs of primary amenorrhea - short stature of adolescent girls, the absence of other sexual characteristics (hair growth, breast growth),
- conditions characteristic of secondary amenorrhea - infertility, irregular periods, established polycystic, previously performed operations on the ovaries, signs of hyperandrogenism (male-type hair growth).
Occur with eating disorders, emotional stress, stress. They are based on changes in the central nervous system, in which the cyclic secretion of the hypothalamic hormones, and subsequently the pituitary and ovaries, is disturbed. The regulation of the genital organs is degraded; as a result, cyclic changes in the endometrium and the ovaries do not occur.
When examining such women for a hormonal panel, there are not always obvious changes. The mechanism of functional amenorrhea is not fully understood, so it is not always treatable.
The main forms are as follows.
- Psychogenic. It occurs on the background of long-term emotional stress, at the same time most often occurs subclinical (hidden) depression. At the same time, the connections between individual brain structures are disturbed, and the secretion of stress hormones (adrenaline, norepinephrine and adrenal glands) increases. All this leads to a change in the synthesis of FSH and LH by the pituitary, the sensitivity of the reproductive organs to sex hormones decreases. The consequence of all these processes is the absence of menstruation.
- Food amenorrhea. Characteristic for poor countries in Africa, as well as for girls who are fond of losing weight and even starvation. It has been established that a decrease in body weight of more than 15% of the ideal will certainly lead to a violation of the menstrual cycle. In some cases, after weight recovery, amenorrhea passes without a trace, but in about 30% it does not respond to treatment even against the background of the normalization of all other indications of the body. Preventing this is the normalization of nutrition.
- On the background of physical exertion. Girls who exhaust themselves with workouts also put themselves at risk for developing amenorrhea. This is due to a special low-calorie diet, a decrease in the mass of adipose tissue in the body, and stress and experiences associated with competitions play a significant role.
- After taking contraceptives. It is known that in 5-7% of women after long-term use of birth control pills, functional amenorrhea is associated with impaired secretion of pituitary hormones. It can last up to a year and sometimes longer. The latter is a poor prognostic sign for subsequent recovery of menstrual function.
Pathology of the pituitary gland
The spectrum of diseases associated with the work of the pituitary gland is wide. It can be inflammatory, autoimmune diseases, functional, tumors, hemorrhages. A thorough examination with the use of modern technologies - CT, MRI helps to establish the true cause. The most common are the following.
- Tumors of the pituitary gland. The most common is pituitary adenoma, which causes hyperprolactinemia - an increase in the level of prolactin in the blood during the examination. This leads to an imbalance of sex hormones, impaired synthesis of FSH and LH and the absence of menstruation. An increase in prolactin in the blood can also develop on the background of diseases of the thyroid gland, adrenal glands.
- Sheehan syndrome. Occurs in women after childbirth, if they were accompanied by a large blood loss. There is necrosis (dying off) of the pituitary against the background of thrombosis of its vessels. Subsequently, the body does not function at all.
- "Empty Turkish saddle." The Turkish saddle is a place on the bones of the skull where the pituitary gland is located. If for some reason it is not there, panhypopituatism develops - a deficiency of hormones regulating the function of the genital organs, adrenal glands, and the thyroid gland. The condition requires lifelong intake of synthetic analogues.
At the same time, external sexual characteristics may not correspond to the chromosomal set or there is a sexual underdevelopment. Например, на первый взгляд девочка по строению имеет мужские половые органы внутри.
- Kalman syndrome. This is a genetic mutation associated with pituitary dysfunction and the simultaneous absence of smell.
- Lawrence syndrome. This causes obesity, delayed sexual development and mental disability. Such obvious symptoms become noticeable in childhood or in adolescents, so the diagnosis occurs at this time.
- Shereshevsky-Turner syndrome. It develops in girls who have not two X chromosomes in their genetic material, but one. They have obvious external symptoms of pathology - short stature, short neck with special pterygoid folds. Sexual development is virtually absent, since their ovaries are completely composed of normal, and not ovarian tissue.
- Swier syndrome. Characterized by the presence of female sexual characteristics, but with the onset of puberty, developmental delays become noticeable. In the study of genetic material is determined by the male set - XU.
- True polycystic ovary. Also called Stein-Leventhal syndrome. At the same time they are covered with a dense shell, hormonal disorders join, resulting in amenorrhea.
- Aromatase enzyme deficiency. Estrogens are partly formed from men. With a deficiency of the aromatase enzyme, the amount of androgens is high, there are "male signs" - body hair growth, an increase in the size of the clitoris and amenorrhea.
- Syndrome of the exhausted ovaries. A condition in which the ovaries are not sensitive to the hormones formed. Along with normal external signs of puberty, there are no periods, infertility develops.
Violation of the anatomy of the genitals
At the same time, obstacles in the path of menstrual blood are formed, resulting in a state of false amenorrhea. Most often, one has to deal with the following causes of amenorrhea, acquired and congenital.
- Congenital malformations. They are detected in adolescence after the girl does not begin monthly. This may be underdevelopment of the uterus and the upper third of the vagina. At the same time, the middle and lower thirds allow for normal intimate relations, but there is no menstrual period with normal ovaries. Such girls in the future may have children only with the use of ART, in particular, surrogate motherhood.
- Asherman syndrome. It is characterized by the appearance of adhesions in the uterus after suffering inflammations and scraping. In this case, the outflow of secretions is also mechanically disturbed.
- The narrowing of the cervical canal. It can be acquired (after heavy labor, scraping, abortion and trauma) or congenital. At the same time, menstrual flow in the uterus is formed, but can not go outside. As they accumulate, there are nagging pains in the abdomen, which do not stop in any way. Elementary inspection and ultrasound helps to find out the cause.
- Dense Hymen. Normally, menstrual blood is easily released through small pores in the film, which separates the vestibule and the cavity of the vagina. In rare cases, problems arise with its release from the vagina, as well as during defloration (during the first sexual contact), with the onset of puberty and the onset of menses.
How to identify and confirm
Independently determine the causes of the absence of menstruation is possible only in the case of physiological processes - postpartum (during breastfeeding) amenorrhea, during pregnancy, menopause, or even in childhood. For the rest, only a specialist can understand it and only after a serious and often expensive examination. Almost always carried out the following.
- Tests for hormones with amenorrhea. Sexual (estrogens, gestagens, androgens, as well as hormones of the pituitary and hypothalamus (LH, FSH, prolactin), thyroid gland (TSH, T3, T4), adrenal glands (cortisol, DHEA) are determined first. "Stock" of eggs.
- Ultrasound of the pelvis. The study helps to identify malformations, accumulation of fluid in the uterus (for example, when the cervical canal is narrowed), and I also have ovarian function for amenorrhea.
- CT or MRI. It is performed to determine the structure of the pituitary gland, identify its tumors.
- Karyotyping A method for determining human genetic data, for example, which set in cells is XX, XY or only one X chromosome.
- Laparoscopy. It is performed less frequently for the purpose of diagnosis, as this is an invasive procedure. When carrying out it is possible to take part of the tissue for their subsequent research.
- Hysteroscopy. It is performed to exclude a mechanical obstacle in the path of menstrual blood, for example, during adhesions in the uterine cavity (Asherman syndrome), constriction or fusion of the cervix.
- Functional tests. Their essence lies in the fact that hormones concentrate (FSH, LH or estrogens) is injected into the blood and then the body’s response is monitored, which can be used to judge the level of damage.
- Other experts. Additional diagnostics often require examinations by an ophthalmologist, a neurologist, an endocrinologist, a therapist.
In secondary amenorrhea, general tests are important - blood, urine, biochemical. So you can exclude metabolic diseases (eg, diabetes), chronic inflammatory processes.
First of all, the effects of amenorrhea affect the possibility of pregnancy. If there is no monthly, most likely, there is no ovulation, and so it is impossible to get pregnant with amenorrhea by natural means. The earlier the pathology is revealed and the treatment is started, the less negative consequences for the woman’s body, and the probability of a favorable outcome is higher. Lack of periods threatens the following:
- infertility - it is necessary to apply auxiliary methods (IVF, surrogate motherhood),
- other gynecological problems - increases the likelihood of endometrial hyperplasia, the formation of polyps and cancer cell degeneration,
- imbalance of sex hormones - virilization ("male hair growth") may occur,
- early menopause - as well as the ensuing consequences, osteoporosis, skin aging, early aging,
- the development of other diseases - many genetic abnormalities are combined or increase the risk of pathologies of other systems and organs.
How can you cause menstruation
Treatment of amenorrhea depends entirely on its type and degree of impairment. The prognosis for the secondary is more favorable, since the preceding menstrual function suggests that the violation has arisen recently and is not a pathology of a genetic nature. The treatment options are as follows.
- Operations Classic laparotomic interventions, laparoscopy, hysteroscopy are used - it all depends on what is supposed to be done for amenorrhea. It can be simply removal of adhesions in the uterus, resection (excision of a part) of the ovary or vaginal plastic (with underdevelopment), cervix. If the cause of amenorrhea is a pituitary tumor, it may be necessary to remove them.
- Hormone therapy. This is the most popular option for how to treat secondary and even primary amenorrhea. Used drugs of different directions. The principle of hormone therapy is described in more detail in the table below.
- Psychological help . With food and psychogenic amenorrhea, a qualified consultation of a psychologist or even a psychotherapist is needed, with the help of which nutrition is established or other problems are solved.
- Normalization of the work-rest mode. In functional amenorrhea, vitamin therapy (groups B, A, E, C) is important, as well as herbs, dietary supplements, homeopathy, and other unconventional methods. In case of not serious violations, they can also have a significant effect. It is necessary to normalize physical activity, sleep, rest and reduce mental work.
False and true amenorrhea
False amenorrhea - This is a condition in which the reproductive system, in principle, functions normally, there are no hormonal disorders. But at the same time, the resulting menstrual flow cannot leave the uterus. The reason may be a congenital anomaly of the structure of the cervix, vagina or hymen, as well as the presence in the uterus adhesions that prevent the release of blood discharge. This condition is dangerous because the blood stagnates, bacteria begin to multiply, this leads to inflammation of the mucous membrane. In the absence of menstruation, there are pains in the lower abdomen, the temperature may rise. Sometimes it is possible to remove mechanical obstacles only by surgery.
True amenorrhea associated with improper functioning of the ovaries, impaired egg maturation and endometrial formation. A woman loses the ability to conceive, becomes barren.
Primary and secondary amenorrhea
Primary amenorrhea is the initial absence of menstruation in a girl over 16 years old. The reason may be genetic disorders of sexual development, congenital or arisen in childhood diseases of the endocrine organs. Sometimes primary amenorrhea is combined with a lack of external sexual characteristics, when the girl has poorly developed mammary glands, there is a formation of a male-type figure.
Secondary amenorrhea is a condition that occurs in women aged 16–45 years who have had menstruation, but have disappeared as a result of illness, stress, and exposure to adverse factors. The cause of secondary amenorrhea are diseases of the ovaries, thyroid, pituitary, brain, and many others.
The consequences of secondary amenorrhea are often a breakdown of the nervous system, a decrease in sexual desire, premature aging of organs, and painful intercourse.
Often with a long absence of menstruation, osteoporosis develops. The risk of cancer of the uterus, ovaries and mammary glands increases.
Lack of menstruation is natural in the following cases:
- When a girl begins puberty, hormonal fluctuation in the body occurs. During the first 2 years the cycle is irregular, it is quite possible the absence of menstruation for several months.
- After menopause, when the functioning of the ovaries stops, and the level of sex hormones is reduced to a minimum.
- If pregnancy has come. During this period, all the forces of the body are aimed at preserving the fetus, its nutrition and normal development. The main role is played by such hormones as progesterone and prolactin, which suppress the maturation of the eggs and strengthen the endometrium.
- When a woman breastfeeds a newborn baby (lactational amenorrhea).
The absence of menstruation after childbirth is due to a decrease in the level of estrogen - hormones, on which the course of all processes of the cycle depends. The dominant role in this period is prolactin, which stimulates the production of breast milk. The duration of the absence of menstruation after childbirth depends on the individual characteristics of the female body. Amenorrhea can last for several months or more than 1 year.
Note: Many believe that it is impossible to become pregnant while breastfeeding, there is no need to protect themselves. However, lactational amenorrhea can end on its own at any time, regardless of whether breastfeeding continues or not. At the same time, it is impossible to understand that the work of the ovaries has resumed, since in the first cycle conception will occur, and menstruations will not come. Sometimes pregnancy is detected only after the baby begins to move. Doctors strongly advise using contraceptives during this period.
Its appearance is associated with the use of hormonal drugs, whose action is aimed at reducing the production of estrogen. Long-term use of oral contraceptives that suppress ovulation, using them to artificially cause a delay in menstruation can also lead to amenorrhea.
Pathological amenorrhea and its causes
Pathological amenorrhea in women always indicates the presence of gynecological diseases or an imbalance of hormones in the body, resulting from a malfunction of the endocrine organs. The disappearance of menstruation in this case is not the only symptom of pathology. Often there are not only signs of reproductive disorders, but also a deterioration in general health.
What diseases are most often detected
Polycystic ovary. In this disease, the structure and functioning of the organs is disrupted due to the formation of many cysts in them. Ovulation becomes impossible. There is a hormonal imbalance. The cause of amenorrhea is hyperandrogenism - an excess of male hormones. Symptoms of the disease becomes hair growth on uncharacteristic for women parts of the body, the appearance of acne on the face and body. Sharp weight gain may occur. Infertility occurs.
Early menopause (ovarian failure). The cause may be disruption of the pituitary gland, mental shocks, prolonged fasting, genetic abnormalities. Menses at the same time disappear at the age of 40 years or even earlier. Symptoms characteristic of menopause appear (hot flashes, headaches, irritability, dry mucous membranes, and others).
False pregnancy. This is a psychological phenomenon. A woman’s desire to become a mother is so great that in the absence of a fetus in the uterus, all the symptoms of pregnancy appear (toxicosis, unusual taste preferences, etc.), menstruation disappears, even the belly starts to increase due to thickening of the fat layer.
Hyperprolactinemia. This condition is associated with excessive production of prolactin as a result of disruption of the pituitary gland. The main symptom of the disease is the release of milk from the nipples, which is not associated with postpartum breastfeeding. There are menstrual disorders until the disappearance of menstruation.
Hypothalamus malfunction (hypothalamic amenorrhea). Characterized by a decrease in the production of hormones pituitary FSH and LH. This causes ovarian dysfunction. Externally, this condition can be determined by the absence of obvious signs of gender.
Tuberculosis and other infectious diseases ovaries; removal of reproductive organs; exposure of the ovaries to radioactive radiation or toxic substances (such as mercury or lead).
Anorexia - deliberate starvation, leading to exhaustion and mental disorder. Excessive physical exertion can also lead to such a state (for example, playing sports until exhaustion). Wanting to lose weight, girls take a laxative and artificially induce vomiting. Gradually, the body loses the ability to digest food. Sharp weight loss, depression, disruption of the digestive system inevitably affect the state of hormonal levels, leading to amenorrhea.
Types of secondary amenorrhea
Considering all these reasons, secondary amenorrhea is divided into:
- uterine (arising after curettage of the endometrium or violation of its structure as a result of diseases),
- ovarian (associated with pathologies in the ovaries),
- pituitary (causes of the disappearance of menstruation are diseases of the brain or neuropsychiatric problems).
Addition: The depletion of the body also occurs in diseases such as typhoid, pulmonary tuberculosis, diabetes, hepatitis and many others. Often, for women, one of the consequences is the loss of menstruation.
Forms of amenorrhea
Amenorrhea can develop in mild, moderate and severe form.
Easy form It is considered the absence of menstruation for 0.5-1 years. However, it does not significantly affect the work of other organs and systems. Treatment with hormones and the elimination of psychological problems often leads to the restoration of menstrual function.
Medium gravity is amenorrhea for 3 years. It is characterized by tides, insomnia, headaches and other signs of disruption of the autonomic nervous system and vascular condition.
Heavy form. A woman of reproductive age has no periods for more than 3 years. At the same time, there is an increase in the uterus, vascular diseases appear.
Diagnosis of amenorrhea
The diagnosis takes into account the patient's age and physique, general health, the presence of chronic diseases, including hereditary and congenital, as well as deviations in sexual development. Takes into account the number of abortions and miscarriages, the nature of the flow of previous pregnancies and childbirth.
Blood hormones of ovaries, pituitary, thyroid, adrenal glands are checked. For examination of the reproductive organs, methods such as hysteroscopy, abdominal and transvaginal ultrasound, diagnostic laparoscopy are used.
Pathologies of the hypothalamic-pituitary system can be detected by X-ray examination and an MRI scan of the Turkish saddle. If necessary, a pelvic tomography is performed.
Video: Causes of amenorrhea, diagnostic methods
If a woman has a lack of menstruation, then it is recommended, first of all, to normalize the diet, eliminate excessive physical exertion, correct the daily regimen, and give up cigarettes and alcoholic beverages.
Note: Использование контрацепции и планирование беременности уменьшают вероятность раннего истощения яичников и наступления преждевременной менопаузы. In addition, protected sex reduces the risk of infection of the uterus and ovaries, inflammatory processes, the consequence of which may be amenorrhea.
Of course, in modern medicine there are several classification schemes for such a disorder, depending on the causes and characteristics of the course of the disease. Depending on the origin of the pathology, it is customary to distinguish two types:
- Primary amenorrhea is a condition in which menstruation is completely absent upon reaching puberty. Simply put, in girls, in whom the normal menstrual cycle was to begin, it never came. As a rule, such disorders are diagnosed in adolescents aged 14 to 17 years. In some cases, the absence of menstruation indicates the presence of a disease. In other situations, such a state is completely normal.
- Secondary amenorrhea is a disorder, which can be talked about if a woman has stopped menstruation for six months or longer. In this case, before the onset of the disorder, the patient at least once had a normal menstrual cycle.
There are other classification systems. For example, amenorrhea can be hormonal, psychological, occur against the background of physical overvoltages, etc.
By the way, some sources often mention degrees of amenorrhea, which, in fact, corresponds to the division into primary (1 degree) and secondary (2 degree) forms of violation.
The main causes of the primary form of amenorrhea
It should immediately be said that primary amenorrhea in most cases is a completely normal physiological state. However, sometimes its causes can be very serious.
- Sometimes this form of disorder is associated with specific genetic abnormalities.
- In some girls, during a physical examination, one or another violation of the cyclic connection between the hypothalamic-pituitary and reproductive system is determined, which may result from injuries or diseases of the brain or the endocrine glands.
- In some cases, during diagnosis, anatomical abnormalities are found in the process of development of the genital organs, for example, the absence of a hole in the hymen, the vagina or cervix is blocked, the uterus is absent, etc. in which the ovaries function normally, but there are mechanical obstacles to the exit of menstrual flow.
Secondary forms of amenorrhea and their causes
Under the influence of what factors does secondary amenorrhea appear? The reasons for the development of this disorder can be different:
- Quite often, the absence of menstruation is associated with polycystic ovaries. With a similar disease, the formation of cysts in the tissues of the ovaries is observed, as a result of which they increase in size and gradually change their endocrine functions. This disease is accompanied not only by amenorrhea, but also by an increase in the level of androgens, enhanced body hair growth, etc.
- Some women have an early onset of menopause. In such cases, there is also a standard for menopause symptoms, including not only the cessation of menstruation, but also mood swings, hot flashes, decreased sexual desire, vaginal dryness, etc.
- Hormonal amenorrhea, which is associated with hormonal imbalance, is quite common, because, as already mentioned, the entire menstrual cycle is closely related to the work of the endocrine system. The causes include impaired ovarian function, the hypothalamic-pituitary system, the thyroid gland (hypothyroidism, thyrotoxicosis).
- This condition may be associated with brain diseases in which there is a violation of the hypothalamic-pituitary system, including tumors, injuries, stroke, damage to certain parts of the brain during heavy labor.
- The absence of menstruation may be associated with taking certain medications, for example, drugs used in oncology, antidepressants, the same hormonal contraceptives.
- The reasons can also include some anatomical changes, the formation of adhesions, in short, obstacles to the discharge of menstrual blood.
- What other factors can lead to a state when there is no monthly? Causes (except for pregnancy) may be in the lifestyle. For example, an unbalanced diet, hard diets, a sharp loss or, on the contrary, weight gain, lack of physical activity, physical exhaustion, nervous overstrain, constant stress, emotional breakdowns - all this affects the hormonal background, and therefore, can lead to menstrual disorders.
What symptoms are accompanied by pathology?
Many women turn to a gynecologist, noting that they have no periods. The reasons, besides pregnancy, of course, can be different. And in order to determine what exactly caused amenorrhea, the doctor will try to collect the maximum amount of information about the patient's condition.
The symptoms in this case may be different, as they depend on the primary violation. For example, if we are talking about a teenager and genetically determined primary amenorrhea, then you can notice the underdevelopment of the genital organs, the disproportionate development of the body, etc. Against the background of hormonal disorders, signs of early menopause can appear.
When it comes to trauma or brain disease, then headaches, mood swings, dizziness, weakness, personality disorders, etc. can join the absence of menstruation. With a false amenorrhea, fluid accumulates in the pelvic organs, which leads to pain in the lower abdomen .
What diagnostic methods are used?
Diagnosis of amenorrhea is a long process. Indeed, in this case it is necessary not only to determine the presence of pathology, but also to establish its exact cause. So what does this process look like and what are the steps in it?
First of all, the doctor will probably try to find out if the patient is pregnant. If there is a lack of menstruation, the test is negative, then this is a serious reason to conduct a full examination for the presence of secondary amenorrhea.
To begin, a general examination is carried out, as well as the collection of information on the presence of risk factors, for example, the patient's enthusiasm for diets, the possibility of mental or physical overstrain, chronic diseases, previous inflammatory processes, etc.
In the future, it is necessary to determine the level of hormones - for this purpose, patients donate blood for analysis. In the laboratory, the amount of prolactin, estrogen, cariotin, sex chromatia, and gestagen is first determined. In addition, tests are needed for thyroid hormones, as well as biochemical blood tests and determination of glucose levels (for obesity, glucose tolerance tests are also required).
Next, an ultrasound examination of the pelvic organs is performed - during the procedure, the doctor can check the patient for the presence of polycystic ovary and also assess the condition of the endometrium. It is also recommended to schedule a change in rectal temperature. A cytological analysis of a vaginal smear for the presence of certain infections is also carried out.
In the presence of adhesions in the uterus, a more thorough examination with a hysteroscope. In case of polycystic ovaries, diagnostic laparoscopy is necessary. If there is a suspicion of a tumor or damage to the pituitary gland, the patient must be sent for examination by a neurologist, followed by an x-ray of the skull, MRI and CT of the brain.
Immediately it should be said that treatment directly depends on what exactly caused the disappearance of menstruation, because amenorrhea is not a disease, but rather its symptom.
For example, if the reason is a violation of the normal hormonal background, then the patient is selected the appropriate hormonal therapy, which may include:
- estrogens, in particular “Divigel”, “Proginova”, “Folliculin” - these drugs are suitable both for endocrine diseases in women and for normalizing the process of puberty in adolescent girls,
- progestins, which are also used to treat both forms of the disease (for example, Duphaston, Norkolut, Utrogestan),
- analogues of gonadotropin-releasing hormones,
- combined ectrogen-progestin oral contraceptives.
The duration of hormone therapy may be different. Some drugs are used in courses to stimulate ovulation (for example, in the treatment of infertility), while others must be taken continuously to support the menstrual cycle until menopause.
In addition, doctors sometimes prescribe some homeopathic remedies, in particular, Mastodinon, Remens, or Klimadinon. These drugs gently affect the hypothalamic-pituitary system, gradually normalizing the menstrual cycle, are well tolerated by patients, and also have a sedative effect.
In some cases, other treatments are required. For example, in the presence of brain tumors, surgical removal, radiotherapy or chemotherapy is required - only after that hormonal treatment is performed to restore the menstrual cycle. In the presence of adhesions, anatomical defects, surgical intervention is also necessary to remove mechanical obstructions and menstrual fluid. The presence of polycystic is an indication for laparoscopy - it is a microsurgical operation, during which the doctor removes cystic tumors. Upon completion, the patient is prescribed hormonal drugs. According to statistics, with the treatment started on time, women manage to become pregnant and successfully carry out the child in the future.
In the event that amenorrhea is caused by any changes in the regime or lifestyle, it is necessary to eliminate all risk factors. For example, patients are recommended to avoid stress, if necessary - to take mild sedatives.
If a cycle disorder is caused by a strict diet, intense physical exertion, then the patient is prescribed a special balanced diet and rest in order to recuperate. If, on the contrary, a woman has gained weight too quickly and there is a risk of metabolic disorders or diabetes, then a diet and a set of physical exercises are also assigned, which are aimed at normalizing the processes of digestion, assimilation of nutrients and overweight control. If, after a few months of maintenance, the menstrual periods have not been able to resume naturally, the patient is selected for appropriate hormonal preparations. Only thus can amenorrhea be eliminated. Treatment in any case will take a little time.
What complications are possible?
Amenorrhea itself is not a threat to human life. But if we are talking about a secondary form of pathology, then primary diseases that lead to the breakdown of the menstrual cycle can be dangerous. In addition, violations of the hormonal background and the work of the reproductive system themselves can lead to unpleasant consequences:
- menstrual disorders and lack of ovulation leads to infertility, which sometimes can not be treated,
- increased risk of early development of so-called extragenital age-related diseases that occur against the background of low estrogen levels, for example, diabetes, osteoporosis, diseases of the cardiovascular system,
- increased risk of developing hyperplastic processes in the uterus, as well as endometrial cancers,
- among pregnant women with amenorrhea (if it originated on the background of hormonal disorders), a high percentage of early miscarriages, preeclampsia, diabetes of pregnant women and preterm birth.
Amenorrhea: folk treatment
This problem can be quite serious. For example, sometimes, making an appointment with a gynecologist, women complain that there is no monthly period. What to do in such cases, to help what drugs and procedures to resort, be sure to tell the attending physician. But many patients are also interested in questions about whether home treatment is possible.
Immediately it should be said that any folk recipes can be used only with the permission of a specialist, as self-medication can be dangerous.
Quite an effective remedy is considered parsley infusion, which is easy to prepare at home. To do this, take three tablespoons of crushed fresh greens of the plant and brew two glasses of water. It is best to leave the medicine in a thermos for 10-12 hours, then strain. You need to take half a glass three times a day, preferably before meals.
Another available tool is a decoction of the husks of ordinary onions. It must be boiled in a little water until it turns a dark color. After complete cooling of the broth, you need to strain and drink three times a day, 100-150 ml.
As some studies have shown, such home remedies are especially effective if the interruption of the menstrual cycle is caused by mental factors. But if its causes are more serious (hormonal disruptions, diseases of the brain, disorders of the reproductive system), then it is impossible to do without medical treatment. Home infusions in such cases can also be used, but only as an aid.
Are there prevention methods?
Amenorrhea is a common problem, do not ignore it. Unfortunately, there are no special means to prevent such a pathology. However, by following some rules, you can reduce the risk of menstrual disorders.
It is necessary to regularly undergo preventive examinations at the gynecologist, because, having identified the disease at an early stage, it is much easier to treat it. If there is a disturbance in the endocrine or nervous system, it is also recommended that a neurologist and an endocrinologist come for check-ups from time to time.
A healthy lifestyle will positively affect the work of the whole organism, thereby reducing the likelihood of malfunctioning of the reproductive system. Proper balanced nutrition, weight maintenance within the normal range, elimination of stressful situations, regular physical activity can all be attributed to preventive measures. Regular but not promiscuous sex life also has a positive effect on the work of the sexual and endocrine systems. In any case, remember that if there is no pregnancy and there is no monthly period as well, then this is a good reason to consult a doctor.
Types of disorder
Depending on the cause of the menstrual dysfunction in girls, primary and secondary amenorrhea is distinguished. In a situation where the disorder is caused by pathological causes, medical intervention is mandatory. In the case of the primary form of the syndrome, there is a complete absence of menstruation in girls who never menstruate. The age at which you can suspect this type of disorder depends on the presence or absence of external signs of puberty.
Pathological disorders are secondary in nature, when there is a cessation of menstruation after their onset. Among doctors, a consensus was reached that the diagnosis of amenorrhea is valid in the absence of a regulation for 6 months or for a period equal to three previous cycles. The list of etiological factors of development of the secondary form of pathology is constantly expanding. In adolescent girls, in most cases, primary syndrome is detected. Among doctors recognized the following classification of amenorrhea, recognized by WHO:
Insufficient endogenous estrogen synthesis in combination with the normal or low content of follicle-stimulating hormone (FSH) in the absence of pathologies of the hypothalamic-pituitary system or a high content of prolactin
Normal synthesis of estrogen, prolactin, FSH
High FSH, premature ovarian failure (PNP)
In addition, the syndrome can be true and false. In the first case, in the uterus, the ovaries of the girl, no characteristic cyclic changes are detected. Such violations, as a rule, are caused by insufficiency of sex hormones. False amenorrhea (cryptomenorrhea) is accompanied by the necessary cyclical changes in the uterus, ovaries. In such patients, ovulation occurs, but menstrual flow is not observed due to anatomical malformations of the genital organs, mechanical obstacles (cicatricial changes, fusion of the vaginal walls).
Why do girls develop amenorrhea
Disorder of menstrual function can be caused by many reasons. Different forms of the syndrome are due to specific etiological factors. Menstrual dysfunction in general is not a condition that is considered from the point of view of a threat to life. The primary form determines the possible relevance of genetic or endocrine disorders. In patients with a secondary form of the syndrome, infertility and anovulation are often found.
Keep in mind, amenorrhea is considered a variant of the norm when using low-dose oral contraceptives. Последние приводят к менструальноподобным выделениям в перерыве между приемом таблеток. Помните, если принимать такие контрацептивы длительное время, происходит истончение внутреннего слоя матки, вследствие чего месячные становятся скудными либо вовсе прекращаются.
This form of the syndrome develops due to genetic, anatomical and psycho-emotional causes. In many patients with primary amenorrhea, there is a lack of regulation in the family history of the mother or older sisters. In addition, menstrual dysfunction is found in Turner syndrome - a chromosomal disease, which is accompanied by characteristic abnormalities of physical development, genital infantilism, short stature.
Anatomical factors in the development of primary amenorrhea in girls are the physical features (lack of weight, thinness, narrow pelvis), deviations in the structure of the genital organs. Exhaustible physical exertion, stress, anorexia are often the culprits of the syndrome. The impact of these factors for the adolescent body is extremely undesirable, since they cause violations at the stage of formation of menstrual function. Among other causes of primary amenorrhea, experts call:
- damage to the hypothalamic structures (tumors, infections),
- ovarian diseases (gonadal dyskinesia, inflammation, urogenital tuberculosis),
- constitutional delay in puberty,
- hormonal pituitary tumors,
- pathology of the uterus (Rokitansky-Kyustner syndrome),
- thyroid disease,
- adrenal pathology (adrenogenital syndrome).
Most girls with secondary amenorrhea are victims of anorexia nervosa and bulimia nervosa. Strict diets, abuse of laxatives, artificially induced vomiting lead to a sharp decrease in body weight and the development of psychosexual disorders, depression, menstrual disorders. In addition, factors for the development of the secondary form of the syndrome are:
- ovarian tumors,
- damage to pituitary structures,
- Cushing's disease,
- thyroid dysfunction, adrenal glands,
- pathology of the uterus (Asherman syndrome),
- hormonal pituitary tumors.
Causes of cryptomenorrhea can be both congenital and acquired. Mainly, the first to be identified. Congenital causes of false amenorrhea, as a rule, are the anatomical features of the structure of the genital organs, for example, atresia (fusion) of the cervix or the hymen. In such cases, menstrual blood accumulates in the uterus (hematometer), tubes (hematosalpinx), vagina (hematocolpos).
Equally important in the development of the syndrome are intrauterine manipulations. Among them the leading place is occupied by abortions. This pathology is diagnosed at the first treatment of the patient to the doctor about pulling or aching pain in the lower abdomen. In the absence of severe symptoms, the cause of the disorder is detected at random during an examination by an obstetrician-gynecologist.
What women need to know about amenorrhea
Amenorrhea is a condition that is characterized by the absence of menstruation for 6 months or more. The absence of menstrual flow in certain cases is considered to be the norm. The latter include:
- lactation period
- the period before puberty (13-15 years),
- period after menopause (45-50 years).
In the life span from the onset of puberty until the beginning of menopause outside of pregnancy or breastfeeding in a healthy woman, the menstrual cycle should be regular.
Amenorrhea is considered a variant of the norm when taking low-dose oral contraceptives, which lead to menstrual-like bleeding in the interval between taking the pills of each cycle. If you take these drugs for a long time, the inner layer of the uterus (endometrium) becomes thinner, and the period may become very scarce or stop altogether.
The classification is based on two types of amenorrhea - false and true.
- physiological is caused by the natural processes in the patient's body (child age, childbearing and lactation, menopause). Such amenorrhea is characterized by the absence of cyclic changes in the ovaries and pituitary,
- pathological - indicates the presence of certain diseases (ovarian dysfunction, inflammatory processes of the genital organs, hormonal imbalance, gynecological manipulations, and others).
Amenorrhea can manifest itself in two varieties, being primary or secondary.
- Primary: found in young girls and is characterized by an absolute absence of menstruation, starting from adolescence. This condition is usually associated with a delay in puberty. Under primary amenorrhea understand the delay in sexual development, in which there is a complete absence of menstruation at the age of 14 years. Also, primary amenorrhea can be observed in the absence of menstruation up to 16 years, but only when there is at least one secondary sexual trait.
- Secondary: it is said about secondary amenorrhea, when a woman of reproductive age after a period of regular or rare, but periodically recurring menstruation stops for 6 months or more. Secondary amenorrhea is a syndrome, not a disease, and refers to the type of menstrual disorders. This pathology occurs in 10% of all recorded violations of the cycle.
Degrees of Amenorrhea: Mild, Medium and Severe
Amenorrhea has 3 degrees of progression (depending on the period of absence of menstruation):
- For 6-12 months - mild form. Timely diagnosis and treatment allows you to quickly cope with the disease,
- For 3 years - an average degree, as a result, vegetovascular complications appear (according to statistics, every second woman)
- More than 3 years is a severe form. The latter is characterized by an increase in uterus size and serious vascular complications. In this case, the treatment is rarely successful.
Symptoms and signs
The main symptoms of amenorrhea two - the absence of menstrual bleeding for more than six months and infertility. These two symptoms are characteristic of any kind of amenorrhea. Amenorrhea differs from the usual delay of menstruation in terms of time - the delay time never exceeds six months.
If amenorrhea is primary, the genitals may be underdeveloped. Girls with this diagnosis have a characteristic appearance: tall, long legs and arms, short body.
Secondary amenorrhea in 4 out of 5 patients is accompanied by vasomotor disturbances:
- nervous system disorders (irritability, bad mood),
- reduced sexual desire
- soreness in the genital area during intercourse.
For the primary form of this pathology, such symptoms and signs are not characteristic.
In the secondary form of amenorrhea, which is caused by endocrine disorders, the symptoms of menopause are observed already at a young age: general weakness, pain in the region of the heart, and hot flashes.
How to diagnose a disease
Before prescribing treatment, the doctor needs to know the causes of the disease. The doctor has a question: “The patient has amenorrhea. What happened in a woman's body? ”A medical examination often reveals an assumption about the causes of amenorrhea, since each type of amenorrhea has its own clinical manifestations. Mostly these manifestations affect body type, the distribution of adipose tissue, signs of virilization.
- General examination - identifying possible signs of somatic (non-sex) diseases: body type, distribution and amount of adipose tissue, striae (stripes on the skin), type of hair growth, development of the mammary glands and discharge from the nipple, etc.
- Laboratory determination of hormones in the blood. The list of hormones depends on the specific situation and is determined by the doctor. Most often it is: thyroid hormones, sex hormones, adrenal hormones, pituitary hormones.
- Progesterone test. It is a reliable method to help determine the level of estrogen, as well as to identify any intrauterine disorders.
- FSH level. In all patients with amenorrhea, the levels of FSH, prolactin and thyroid-stimulating hormone in serum are determined. An increase in FSH implies a violation of ovulation.
- Prolactic level. Determining the level of prolactin in the blood plasma (an increased number indicates the need to examine the pituitary gland for prolactinomas),
For diagnostic purposes, the following are used to establish the causes of amenorrhea and further eliminate them:
- hysteroscopy (a special hysteroscope device is inserted into the uterine cavity through the vagina and the cervical canal),
- ultrasound examination of the pelvic organs (ultrasound examination is most informative for ovarian, uterine and adrenal amenorrhea. It reveals structural changes that led to the development of the disease.),
- X-ray examination of the Turkish saddle (in case of suspected prolactin),
- intravenous pyelography (with suspected dysgenesis of the cervical ducts, combined with kidney abnormalities),
- computed tomography and MRI if necessary.
Most treatment of amenorrhea is accompanied by the appointment of a course of hormonal drugs that can replace the lack of necessary hormones and improve the functioning of the pituitary gland, the hypothalamus and normalize the production of hormones by the ovaries.
With well-chosen treatment, it is possible to get rid of secondary amenorrhea, but the primary form requires a more thorough correction by the doctor.
Amenorrhea means the inability of a woman to conceive, so the main goal - the restoration of fertile function. After finding out the true cause of amenorrhea, treatment is prescribed. Treatment of amenorrhea includes hormone therapy in conjunction with physiotherapy.
- Amenorrhea, associated with a sharp decrease in weight, is treated with diet therapy. After the restoration of normal body weight, menstruation is restored.
- With obesity, on the contrary, recovery is achieved by reducing weight.
- In case of congenital anomalies, operations are carried out, for example, the creation of a vagina in the absence of it or the dissection of a hymen.
- With polycystic ovaries, it is important to reduce the symptoms of increased androgen production and restore ovulation. To do this, use contraceptives and drugs that reduce the synthesis of androgens in the adrenal glands and ovaries.
For the treatment of the primary form, the following solutions are proposed:
- Correction of mental states
- Vitamin therapy,
- Diet food,
- The withdrawal from stressful states and the strengthening of the nervous system,
- Hormonal therapy,
- Surgical intervention.
For the treatment of the secondary form of predetermined, as the above measures, and the following:
- Lifestyle change,
- Hormonal drugs,
- Compliance with the regime of work and rest,
- Refusing to lose weight.
With primary amenorrhea
Correction of nutrition and moderate exercise are necessary for building muscle, strengthening the body. The use of vitamins can improve the functioning of the ovaries. Replacement therapy is prescribed to normalize the hormonal background.
If the cause is a shortage of female sex hormones, then treatment is carried out using combined oral contraceptives (such as Janine, Yarin) containing a balanced amount of estrogen and progesterone. In the presence of genetic abnormalities in sexual development, for example, in Turner's syndrome (a rare chromosomal disorder), hormone therapy is carried out for life.
If the cause of primary amenorrhea is the presence of mechanical interference that prevents the removal of blood, then surgery is performed to eliminate them.
With secondary amenorrhea
The method of treatment is selected depending on its cause. So, in anorexia, psychotherapy, reflexotherapy, and treatment with sedatives are used. Measures are being taken to eliminate hormonal disorders with the help of drugs based on the hormone FSH, human chorionic gonadotropin (hCG), and also estradiol.
To restore the cycle and stimulate ovulation, Puregon, Prophase, Ovitrel, Klostilbegit are prescribed. In the presence of disorders associated with the imbalance of the pituitary hormones, homeopathic medicines such as Remens, Mastodinone are widely used, which reduce the production of prolactin, normalizing the level of estrogen.
Drug treatment of polycystosis of the ovaries is carried out with the help of drugs that suppress the production of androgens (Byzanna, Diane 35, Marvelon). If medicinal treatment is not enough, then surgical removal of the affected part of the ovary is performed using laparoscopy.
Comprehensive treatment of amenorrhea and compliance with the recommendations of the doctor in many cases help to get rid of the pathologies and restore menstrual function.
This pathology can be false or true. In the latter case, amenorrhea may have a physiological and pathological nature. One of the causes of the disease is hypofunction of the ovaries, during which the follicular apparatus is reduced. His defeat disrupts the production of follicles. This pathology appears in the womb, as well as in childhood with various inflammations. Inflammations can cause ovarian hypoplasia. Diagnosis is carried out by ultrasound. For therapeutic purposes, hormone therapy is used, causing a reaction similar to the menstrual one. However, this treatment does not help the restoration of reproductive function.
Due to the lack of functioning of the pituitary-hypothalamus system, a steady formation of delayed sexual development occurs, in which there is no menstruation and ovulation. There is a weak expression or complete absence of secondary sexual characteristics, the body is disproportionate, there is insufficient development of the mammary glands.
Primary amenorrhea is associated with anatomical changes in the uterus and vagina, in some cases, there is no virgin membrane and vagina. This absence may be complete or partial. Patients complain of pain in the lower abdomen, heaviness in the pelvis and the absence of menstruation. Similar conditions are treated only surgically, with the use of excision and subsequent plastics. Natural progestogens, estrogens, other types of hormonal drugs and anti-inflammatory drugs are used as drug therapy. The course of treatment ranges from 3 to 6 months, in addition immunotherapy is carried out.
In the case of pathological changes in the hypothalamus, the appearance of secondary amenorrhea is also associated with changes in the central nervous system. The diagnostic measures take into account the symptoms of galactorrhea, determine the presence of gonadotropic hormones, sex steroids and prolactin in the blood. The presence of a pituitary tumor is determined by x-ray.
Secondary amenorrhea occurs as a result of organic tumor of the adenohypophysis with circulatory disorders and necrotic changes. This pathology acts as a clinical sign of some diseases.
There is an ovarian form of secondary amenorrhea, known as various types of syndromes associated directly with the ovaries. Developing tumors, ionic radiation damage and removal of the ovaries have a negative effect.
As a rule, secondary amenorrhea acts as a symptom of the underlying disease. Therefore, in addition to traditional diagnostics, studies are carried out by genetic, morphological, endocrinological and other modern methods. All therapy concerns the treatment of the underlying disease. If the causes of the pathology are not finally established, then, first of all, the menstrual function is restored. The use of drug therapy is allowed only after a thorough examination to exclude the tumor nature of the disease.
The main symptom of the disease is the complete absence of menstruation. This leads to impaired reproductive function and infertility. These manifestations are characteristic of any amenorrhea, other symptoms are specific and appear only in certain situations.
False amenorrhea results from anatomical disturbances when menstrual blood accumulates in the uterus. There are painful contractions in the lower abdomen in the days of the alleged menstruation. Pain accompanied by headaches, nausea, an increase in the mammary glands. In this state, patients are within 2-3 days.
If amenorrhea has arisen under the influence of a pituitary tumor, then galactorrhea appears in the form of milk outflow from the breast, irritability, emotional instability and other neurological signs along with the main symptoms.
Genetic anomalies of primary amenorrhea are determined by underdeveloped genitals. In girls, the proportions of the body may be disturbed: with a high growth, the body is very short, and the arms and legs are long. Endocrine disorders in secondary amenorrhea manifest as menopausal symptoms. Young women experience a feeling of pain in the heart, constant weakness and hot flushes. The presence of polycystic ovaries leads to obesity, excessive hair on the face and body, increased insulin levels.
Treatment of amenorrhea
The choice of therapeutic measures takes into account the severity and form of the disease. В любом случае врач назначает продолжительную заместительно-гормональную терапию, восстанавливающую нормальные функции яичников.
- When endocrine disorders of ovarian function, estrogens are used. The same is recommended for girls who have delayed puberty, if there is no neurological pathology.
- Primary and secondary amenorrhea is treated with gestagens.
- In the presence of polycystic ovary syndrome, gonadotropin analogues are used. This contributes to the induction of ovulation and makes it possible to become pregnant. These drugs are used for disorders of the hypothalamus and pituitary, causing primary amenorrhea.
- For the treatment of infertility with secondary amenorrhea, certain types of synthetic nonsteroidal drugs - anti-estrogens are used. Under the action of this remedy, ovarian hyperstimulation occurs.
Along with hormonal agents, self-administered homeopathic herbal remedies such as Klimadinon, Remens, Mastodinon are allowed. With their help, the hypothalamic-pituitary system is adjusted and the menstrual cycle is normalized.
In addition to hormonal and homeopathic treatment, in some cases there is a need for surgical intervention. For example, a pituitary tumor causes neurological pathology. Therefore, the pituitary gland is removed or destroyed by surgery, as well as using radiation therapy.
Some patients suffer from amenorrhea due to physiological disorders such as underweight, excessive exercise and stress. In these cases, therapeutic measures are aimed at eliminating the provoking factors. The result is an independent recovery of the menstrual cycle. Full menstrual function can be provided, provided the minimum mass of the female body is 44-46 kg.
All patients are advised to observe a healthy lifestyle and a certain regimen that ensures a speedy recovery. Compliance with diets and exercise is very useful for endocrine disorders and excess weight. Thus, the number of hormonal disorders decreases, other diseases are prevented.
By itself, amenorrhea does not cause serious disorders in the body. It is a consequence of other, more serious diseases. Therefore, when there is amenorrhea - the absence of menstruation, with untimely and improper treatment, various complications are possible.
The most dangerous of them are:
- Infertility. In this case, the reproductive function is impaired as a result of diseases of the genital organs, endocrine diseases, during premature or normal menopause. The ovaries are unable to produce hormones that support normal ovulation and the menstrual cycle.
- Osteoporosis, accompanied by lesions of bone tissue.
- Atherosclerosis, which affects the arterial vessels.
- Various autonomic disorders and obesity.
Causes and signs of primary amenorrhea or lack of menstruation in girls
The beginning of the reproductive age of girls are considered the first menstruation, menarche, which normally should come in the period from 9 to 14 years. On average, the first menstrual cycle begins at the age of 11-12 years, at the same time secondary sexual characteristics begin to develop: pubic hair growth appears, mammary glands grow. But sometimes menstruation does not begin even after 14, 16 years, then they talk about such a pathology as primary amenorrhea.
Causes of primary amenorrhea
This form is not very common, as amenorrhea is secondary, amenorrhea, which develops due to acute or chronic diseases, surgeries, and so on. Causes of primary amenorrhea can be such states:
- violations of the intrauterine development of the reproductive organs,
- genetic disorders
- endocrine system malfunction
- psycho-emotional factors
- serious physical exertion.
By type of lesion, primary amenorrhea, secondary, however, can also be classified as follows:
- hypothalamic-pituitary type,
- gonadal dysgenesis,
- aplasia of the uterus and vagina.
But it is worth remembering that in the case of primary amenorrhea, it is a question of congenital anomalies of development, and in the case of secondary amenorrhea, acquired ones.
When intrauterine formation of the external and internal genital organs most often occur anomalies of the output tract. These include non-perforated hymen, transverse vaginal membrane, vaginal agenesis, testicular feminization.
A non-perforated hymen is a non-perforated nib, which normally should be. As a result of the absence of a monthly opening, which start on time and go as expected, they simply do not find a way out of the vagina. Over time, menstrual blood accumulates in the uterus, the upper sections of the vagina, causing them to stretch. Patients may complain of pelvic or lower abdominal pain. When viewed visible chaff, stretched, purple color. The treatment in this case is simple, a surgical opening of the chaff is sufficient.
The transverse vaginal membrane develops when the upper part of the vagina is not properly formed. As a result, the upper part merges with the bottom. The result of this pathology is also a violation of the outflow of menstrual blood, and, as a consequence, primary amenorrhea. With this pathology, there are no violations of the hormonal system, sexual development is also not delayed. Diagnosed with the gynecological examination. Treatment is a small surgical procedure called a chaff resection.
Agenesia of the vagina, it is Mullerova agenesis, which is also called aplasia of the uterus and vagina. With this pathology, the vagina and uterus may be completely absent, or there is a rudimentary uterus and a developed distal part of the vagina. At the same time, there is no disruption in patients in terms of puberty, there is no hormonal imbalance. Puberty begins on time, external genitals correspond to the norm. The diagnosis is confirmed after gynecological examination and ultrasound - the main features of the pathology is the lack of a developed vagina, uterus, but the ovaries are fully formed. The treatment is plastic neovagin, but the patient remains barren.
Testicular feminization occurs when insensitive to the action of androgens in male patients - as a result, they form a female phenotype (femininity). With this pathology, the mammary glands develop, but the uterus is absent, the vagina is formed in the form of a blind pocket. Developed and testicles that are either not lowered, or migrate to the labia majora. In this case, the treatment consists in the surgical formation of neovagin in order to ensure the possibility of sexual life.
Cases of primary amenorrhea are characteristic of many genetic abnormalities, but it is most typical for such disorders as gonadal dysgenesis, that is, ovarian hypoplasia. There are three forms of pathology: typical dysgenesis, pure and mixed (atypical).
The typical form is diagnosed at the birth of a girl. Observed lymphatic swelling of the upper torso, feet and hands, neck. With the growth of the girl, the barrel-shaped chest, short neck, mandible are underdeveloped, the palate has an arcuate shape, the teeth are deformed, the skeleton is deformed. Typical is a person with such a violation - children are like old people. In addition, characteristic ptosis, squint. There are pathologies of the cardiovascular, excretory system.
For a smoothed typical form, amenorrhea is characterized by primary, short neck, short stature, an anomaly in the development of the elbow joints.
The pure form of dysgenesis has other manifestations. Girls have tall stature, many have eunuchistic physique. The mammary glands are poorly developed or not developed at all, there are no secondary sexual characteristics, the genitals are reduced in size. Instead of the ovaries, there are gonadal strands. Pathology is detected in patients with both male and female genotype. In patients with a male karyotype, the clitoris may be hypertrophied, and the uterus - rudimentary. In patients with a female karyotype, sexual infantilism is less pronounced, there may even be scant discharge instead of menstruation.
As for atypical dysgenesis, experts consider it as one of the variants of hermaphroditism. Pathology is detected immediately after the birth of the child - the external genital organs are incorrectly formed in the newborn, so it is necessary to decide the question of which sex he belongs to.
When puberty in patients, facial hair appears, voice timbre decreases, the clitoris increases. In this case, hair growth occurs on the female type, but not so pronounced. The mammary glands are present, but not developed properly, the uterus with fallopian tubes is hypoplastic (of insufficient size).
Treatment of gonadal dysgenesis begins with the surgical correction of the external genital organs in order to give the child a certain gender. Subsequently, upon the onset of puberty, hormone replacement therapy is carried out. Sex life with such disorders is possible, but the patients remain sterile.
Endocrine disorders that can cause primary amenorrhea include various disorders of the hypothalamic-pituitary axis.
The hypothalamus is the part of the brain that controls the work of all body systems, including the endocrine system. As for the pituitary, this part of the brain is responsible for the synthesis of many hormones, among which they affect the development of the human reproductive system. Accordingly, in the event of malfunction of the hypothalamus or pituitary gland, human reproductive function inevitably occurs along with other pathologies, of course.
Such disorders can occur before puberty - growth retardation, obesity, or, conversely, underweight, mental disorders, and so on, but much depends on the type of disease.
In some cases, abnormalities in the work of the hypothalamus and pituitary gland are detected only during puberty, when patients have sexual infantilism, hypoplasia of the genital organs, along with the absence of secondary sexual characteristics. Analyzes show low levels of estradiol and gonadotropins.
Treatment for such conditions - hormone replacement therapy, if possible - the treatment of the underlying disease.
Modern girls often have amenorrhea, the causes of which do not lie in the field of physiology. Puberty is a serious and difficult period for a girl, especially in psycho-emotional terms. Due to hormonal changes in the body, the child’s nervous system becomes more sensitive, hence mood swings, impressionability, adolescent maximalism, and the like.
That is, the load on the nervous system itself is high. It adds pressure from parents (marks at school, compulsory visits to circles, classes with a tutor), pressure from peers (standards of beauty, fashion, subcultures), pressure from the public (rules of behavior, traditions). As a result, chronic stress is formed, which can cause a delay in menstruation.
Diagnosis in such cases is simple, but requires the participation of a child psychologist. With regard to treatment, it can be as the appointment of fortifying, sedatives, and psychotherapy sessions.
Parents need to create a favorable psycho-emotional atmosphere in the family, preventive conversations with the girl on the subject of fashion, relationships with peers, school and what usually affects self-esteem and self-identification of the teenager.
Diet as the cause of amenorrhea
Delay menarche, and puberty in general, can cause and too strict diet, which the girl can adhere to for medical reasons. Although most often a strict diet is observed under pressure from peers, the media, which promote beauty standards that are far from healthy. Often at this age anorexia occurs, bulimia - in these conditions, of course, amenorrhea is not excluded.
Delayed sexual development due to excessive weight loss is due to the fact that a certain percentage of fat must be contained in the body to produce enough estradiol. Especially important is the fat, which is located in the lower abdomen and sides of a woman. And estradiol is the hormone that provides normal growth of the endometrium of the uterus. In the first half of the cycle, the thickness of the endometrium should be 10-12 mm, then the uterus becomes prepared for the upcoming conception. Ovulation occurs, and after it comes either a pregnancy or the second phase of the cycle, which ends with menstruation.
If the thickness of the endometrium is lower, the uterus is not ready for conception, and if so, then the egg does not come out, ovulation does not occur. Accordingly, there will be no monthly. With low estradiol production, the thickness of the endometrium reaches only 4-5 mm by the time of the expected ovulation.
If menarche delay is associated with weight deficiency, treatment is to normalize nutrition, although this is often not possible without a prior course of psychotherapy.
In the primary form of amenorrhea, many patients experience too high physical activity. Sports achievements are great, but it is excessive physical exertion that causes a delay in sexual development, as the body reserves all its strength for strength and endurance - there is simply no way for the puberty of the resources.
In addition, there are violations of the hormonal system, more precisely, sex hormones - increased testosterone production, and the production of estrogen is reduced. For this reason, parents must control the physical activity of the child. No sporting achievement is worth serious violations in the body.