Amenorrhea - this specific pathological condition in which menstrual no more than three months after the onset of menstruation.Amenorrhea uterine happens: the true pathological, physiological, false, primary and secondary.Young girls amenorrhea may last up to a year.This duration of amenorrhea common in those women whose menses were established relatively recently.In older women may occur spontaneous cessation of menses (menopause).Amenorrhea after childbirth lasts about two years, provided that the woman retains the natural feeding during this period.
Treatment of amenorrhea includes a considerable number of aspects, including a full medical history to determine the causes of amenorrhea and a survey of women in the complex.
Causes of amenorrhea
causes of amenorrhea can be quite a lot.
If true amenorrhea (the cyclical nature of the changes in the hypothalamic-pituitary-ovary-uterus is absent), the reasons for its occurrence may make such factors as pregnancy, lactation, me
If true pathological amenorrhea distinguished: the primary form of amenorrhea and secondary form.The true nature of primary amenorrhea is the pathological form of the etiologic factor values divided into the uterine amenorrhea due to functional disorders of the gonads and amenorrhea, which is due to ektragonadnymi reasons.
Primary amenorrhea true pathological nature as a result of dysfunction of the gonads occurs because of: gonadal dysgenesis syndrome Morris (testicular feminization).Once this condition is called male hermaphroditism.Gonadal dysgenesis is a fairly rare disease, caused by genetic defects because of defects which develop gonads.Its frequency is 1 in 10,000 newborns.
true pathological amenorrhea, which is caused by ekstragonadnymi causes, develops due to: congenital adrenogenital syndrome, hypothyroidism, CNS lesions in the hypothalamic-pituitary region, destruction of the endometrium.
Adrenogenital congenital syndrome develops because of pathology in the adrenal cortex with excessive production of androgens.It is this hormone also karyotype 46 XX.In this state in girls during puberty there is a primary amenorrhoea.In hypothyroidism there is a delay of sexual development and, consequently, the delay menstruation (amenorrhea).Lesions of the hypothalamic-pituitary region may have an organic origin in nature (trauma, infectious and toxic lesions, tumors) and psychological nature of origin.
amenorrhea often occurs in manic-depressive psychosis, schizophrenia.Such a patient is typically contingent hospitals with psychiatric profile.Anorexia nervosa can also be attributed to the cause of amenorrhea, which is also true cerebral form of primary amenorrhea is the pathological character.
to defeat CNS accompanied by amenorrhea, include: chronic arachnoiditis, meningoencephalitis;hypothalamic tumors and trauma, manifested by type hypophyseal syndrome, diencephalic-hereditary retinal degeneration.
amenorrhea syndrome may occur due to uterine form of amenorrhea because of the anomalies of the uterus, as well as due to the influence of damaging factors (tuberculosis of the uterus and the destruction of the endometrium).Reduced susceptibility to sex hormone receptors endometrium, also plays a role in the occurrence of amenorrhea masterbatch form.
Secondary amenorrhea occurs because the real parts of the central nervous system lesions, the development of diabetes, disorders of the thyroid and adrenal corticosteroids and receiving combined oral contraceptives, etc.
false amenorrhea occurs due to mechanical obstruction release of menstrual blood out of the uterus.These obstacles include: imperforate cervical canal, vestibule and hymen.These processes take place without CNS pathologies.
hypogonadotropic amenorrhea develops due to decreased secretion of TG (pituitary gonadotropins).Such a condition results in a decrease in ovarian and menstrual function failure in the form of amenorrhea.Reasons for reducing this hormone may be associated both with the hypothalamus and pituitary gland to.
risk factors in the development of amenorrhea are: physical and emotional load, stress, eating disorders.
symptoms of amenorrhea
symptoms of amenorrhea depends largely on the reasons that caused it.
If true physiological amenorrhea is observed cyclic changes in the pelvic organs, menstruation is absent.Decreased ovarian function and lacking hormones (progesterone, estrogen) for implementing changes in the endometrium throughout the cycle.
When false amenorrhea part of its manifestations are hematocolpos, hemometra, gematosalpinks.In some cases, the menstrual blood may be to throw through the pipes into the peritoneal cavity and provoke "acute abdomen."
If true amenorrhea due to gonadal dysgenesis clinical manifestations are: underdevelopment of internal and external genitalia;irregularities in the structure of the chest, the cardiovascular system, ureters.
When false male hermaphroditism symptomatic manifestations depend on its shape.When complete form marked female phenotype with normal development of mammary glands.The uterus to the ovaries is absent, and the vagina ends blindly.External genitalia are developed on the female type.One-third of patients with this pathology, the testicles are located in the inguinal canal with the formation of an inguinal hernia, the other third of the testicles are located in the interior of the labia.In other patients testicles are located within the abdominal cavity.
When amenorrhea caused by hypothyroidism, there is insufficient development of sexual organs, violation of bone tissue.Also, there is a delay of puberty (15 years).Patients with such disorders have a small height (no greater than 145-150 cm).
In secondary amenorrhea true there are common symptoms, such as tachycardia, increased body hair, increased nervous irritability and irritability, sweating, lack of menstruation, increase in stomach, nausea and vomiting, moon face.
Primary amenorrhea initially divided into false and true, where the latter may be physiological and pathological character.Under pathological forms of primary amenorrhea primary reasons for its development are: impaired function of the gonads and ekstragonadnye reasons.
gonadal dysgenesis provokes the development of primary amenorrhea.There are four forms of gonadal dysgenesis: classical or typical, clean, mixed and blurred.The classic form of the characteristic element is the karyotype 45 CW for clean - XX karyotype 46, for the mixed - karyotype 45 X0 / XY 46, while, at the gonads has a mixed structure.For obliterated typical karyotype 45H0 / 46HH and has the character of a mosaic, in which the symptomatic manifestations depend on the percentage of normal and aberrant cell clones.
for the diagnosis of this condition are a major study on the genetic level (determination of the karyotype and the level of sex chromatin).Treatment of this disease when detected in the chromosome is surgical removal of the gonads due to a high risk of malignancy.Upon detection of karyotype 46HH, 45H0 prescribe hormone replacement therapy.Apply estrogens (mikrofollin 500 mg / day for 3 weeks; estrofem Table 2. 2 p / day; Proginova Table 1. 3p / day for the same number of days).Was repeated three cycles, and then proceeds to therapy progestins (oil solution of 1% -2.5% progesterone, 0.5 mg or 1 ml per day; Table 3 Pregnin 2 r / day; Table 1 Norkolut. / Day; Turinal 2Table. / day; Djufaston 1 tab. 2 / day).Progestogens drugs taken from 16 th to 26 th day of the cycle.
hypovarianism considered less common cause of primary amenorrhea, uterus, and therefore poorly understood.Alternatively, the pathology is the syndrome called "resistant ovary."In the ovaries is determined by a decrease in follicular unit.The defeat of the apparatus to produce follicles in the ovaries may occur in utero at various pathologies during pregnancy, or as a child in the development of inflammatory processes.Recent circumstances lead to hypoplasia of the ovaries.In the diagnosis of this condition is determined the level of gonadotropin in the blood, and sex steroids.Determine the high content of FSH and LH on the background of a low content of estrogen.A valuable method for the diagnosis of drug-resistant ovarian considered ultrasound (ultrasound) of the pelvic organs.Treatment of patients with this pathology is quite complex and due to the lack of certain ideas about the etiology and pathogenesis of this disease.The most common hormone, clomiphene.Against the background of such treatment can achieve the onset of the reaction, similar to menstrual.But reproductive function in these patients is impaired.
Against failure of the hypothalamic-pituitary-resistant forms delayed sexual development, which is accompanied by lack of ovulation and menstruation.Secondary sexual characteristics are absent or mild.There is a disproportion of the body, the breasts are underdeveloped.
Primary amenorrhea occurs when anatomical changes in the type of malformations of the uterus and vagina (imperforate cervical canal and vestibule).Patients with this type of abnormalities detected absence of the hymen and vagina.It can be either partial or complete.Patients complain of abdominal pain, amenorrhea, feeling of heaviness in the pelvis.The treatment of such conditions and is exclusively surgical excision of the hymen, as well as dissection of the vagina, followed by plastics.After the operation the patient is assigned to medical therapy (hormonal preparations in the form of natural estrogens and progestogens, anti-inflammatory drugs) for three to six months and immunotherapy for the treatment of amenorrhea.Reviews of this treatment strategy have yielded positive results.
As previously indicated, depending on the degree of destruction of the hypothalamus-pituitary-ovary-uterus is divided into: hypothalamic, pituitary, ovarian, uterine form of amenorrhea.
Secondary amenorrhea due to pathological changes in the hypothalamic region may be caused by such changes in the central nervous system as the primary.
It includes: psychogenic amenorrhea, anorexia nervosa, cryptomenorrhea (seen in those women who have expressed a neurosis associated with the obsessive desire to have children), neuro-psychiatric disease, amenorrhea along with galactorrhea (developed on the basis oftumor in nulliparous women in the area of the hypothalamus or pituitary gland, on the grounds of mental trauma origin).When amenorrhea galactorrhea with two call it causes a decrease in production output prolaktostatina hypothalamus, pituitary prolactin inhibition.
In the diagnosis of amenorrhea caused by this pathology taking into account the sign of galactorrhea, determine the level of prolactin, sex steroids and gonadotropin-releasing hormone in the blood.If you suspect a tumor of the pituitary gland is carried out X-ray examination.Treatment consists in the following: the presence of a pituitary tumor surgical treatment, in other cases, prescribed drugs that reduce prolactin levels (Parlodel, Bromocriptine, Ronalin 0.5 tablets once a day with a gradual increase in dose to three tablets a day under the control levelprolactin).In some cases apply Dostineks - 1 tablet every day for a week.To restore ovulatory ovarian use Clomid, chorionic gonadotropin, Klomifentsitrat.
In secondary amenorrhea induced pathological disorders in the pituitary region, its cause is organic lesion of anterior pituitary tumor in the pituitary gland violation of circulation with signs of necrotic changes.Also, secondary amenorrhea may be a clinical sign in certain diseases.Postpartum hypopituitarism develops due to necrosis of the anterior pituitary gland due to vasospasm in the massive loss of blood during childbirth or bacterial shock.Accompanied by this pathology: amenorrhea, agalactiae, a headache by type of migraine, anorexia, dizziness, frequent and copious, hair loss, atrophy of the mammary glands.
During the survey conducted laboratory diagnostics blood test for hormones: TSH, ACTH, cortisol, estrogen, thyroid hormones and so on. It is also carried out medical history, find out where the onset of the disease connection with septic shock or hemorrhage in childbirth, abortion.Therapy is to appoint anabolic hormones, estrogen therapy and cyclic progestins, corticosteroids, thyroid hormones (if necessary).
Secondary amenorrhea uterine pathology ovaries, as it is called ovarian form of amenorrhea.This form of pathology is divided into: a syndrome of "premature ovarian failure", polycystic ovary syndrome, amenorrhea due to ovarian androgen tumors, amenorrhea due to ovarian damage ion emission and removal of the ovaries.
syndrome "premature ovarian failure" is considered a large number of factors such as exogenous nature and hereditary.Stressful situations and infectious diseases usually give rise to the disease.Also syndrome amenorrhea for this disease is characterized by: fatigue, rash, headaches and heartaches.Diagnosis of this syndrome is to conduct tests with female hormones at which provoked a reaction similar to menstrual.This test shows the functional safety of the endometrium.Test with gonadotropins is negative, which also indicates a decline of ovarian function.Treatment is carried out hormone replacement therapy before menopause.
Polycystic ovary syndrome is the most common cause of secondary amenorrhea pathological character.Characterized by impaired steroidogenesis in the ovaries due to poor function of enzyme systems, which contributes to increased production of androgens by the ovaries.Clinical manifestations: an increase in size of the ovaries with multiple cystic changes in the follicles and thickening of the capsule, amenorrhea, primary infertility, excessive body weight, hypertrichosis.Diagnosis is to conduct diagnostic laparoscopy and ultrasound examination of the ovaries.Treatment is reduced to the operational methods of therapy.Laparoscopy is performed with thermal or electrocautery of the ovaries.After the laparoscopy, the menstrual cycle is restored.In secondary amenorrhea due to ovarian androblastoma well as surgical treatment.
reason being provocateurs for the appearance masterbatch form of secondary amenorrhea may be: tuberculosis of the uterus;hysteroscopic scraping the uterine cavity with the damage of the basal layer of the endometrium;endometrial damage by thermal or chemical burns;adhesions in the uterus (spikes);amputation of the uterine body.
Amenorrhea itself is not a symptom of a number of diseases or nosologic form.In this regard, clinical signs may be identified with amenorrhea of the underlying disease.Diagnosis etiopathogenesis amenorrhea includes not only medical history, ultrasound, bimanual examination, but modern morphological, genetic, radiological, endocrinological, and other methods of examination.When amenorrhea treatment should be directed to treatment of the underlying disease.If you are unable to determine the cause of the end of secondary amenorrhea, then treatment should be aimed at the restoration of menstrual function.Drug therapy is prescribed only after a full examination of the tumor with the exception of the nature of the disease.