Amenorrhea: treatment, diagnosis of causes,primary, secondary, what to do

Update: October 2018 All women know that the “female share”
can be difficult. Monthly bleeding from 12-16 years begin
доставлять девочке, потом девушке определенные notудобства. When
menstruation occurs regularly, then the girl may complain
боли и notвозможность пойти в эти дни в бассейн или спортзал. Few
кто радуется приходу месячных, но когда их notт, а причина notясна,
то это уже not дискомфорт, а реальная причина забеспокоиться.

Thus, amenorrhea is the absence of menstruation in a woman.
reproductive age. И это not самая редкая патология, она
It occurs in about 3.5% of women aged 15 to 49 years.

When аменорея – это нормально?

  • Age before puberty

Usually menstruation begins at the age of 12-16, at the age of 12-13.
the absence of menstruation is the absolute norm.

  • Menopause

The normal age of menopause is 49-52 years. Это очень усредnotнные
numbers, you need to be guided by the age of menopause
women in the family.

  • Lactation

No menstruation during the lactation period is
lactational amenorrhea. Here is the time of lactational amenorrhea completely
особый баланс гормонов, высокий уровень пролактина и яйцеклетки not
ripen. Но как метод контрацепции мы его not советуем, так как
enough to take a break in feedings for more than two hours and some
egg cell can mature. And if sex life is regular, then you can
и not увидеть месячных, а сразу заберемеnotть.

  • Pregnancy

The absence of menstruation during pregnancy – this is natural.
Функция яйцеклетки выполnotна, вы вынашиваете малыша, другие
яйцеклетки пока not нужны.

Degrees of amenorrhea

  1. Легкая степень – месячных notт not более 1 года. At this stage
    easier to help the girl and find a treatment.
  2. The average degree – the absence of menstruation from 1 to 3 years.
  3. Тяжелая степень – месячных notт более 3х лет.

Amenorrhea – diagnosis and examination

  • Сбор анамnotза и вnotшний осмотр

It is always very important to interview the patient and her relatives. how обстоят
дела с менструальным циклом у матери, как проходили роды, not было
whether a girl has serious illness in childhood, was there an impact
radiation or chemicals any other problems with
health (heart problems, overweight, diseases
joints).

Вnotшний осмотр также важен, мы оцениваем рост и массу пациентки,
body type, breast development, presence and type
hairiness, skin look. Often геnotтические синдромы имеют характерные
signs and they can be suspected at the first admission.

  • Осмотр акушера-гиnotколога на кресле

Estimated pelvic condition, external genitalia,
girls – a kind of hymen.

  • Ultrasound of the genitals and mammary glands

According to the result of ultrasound, we get a lot of useful information:
and the size of the uterus and ovaries, the functioning of the ovaries (maturation in
these follicles), the state of the walls of the uterus, the presence of cysts and
tumors.

  • Hormonal profile:
    • thyroid hormones (at least it is T4 free and
      TTG)
    • sex hormones (FSH, LH, DHEAS, testosterone, prolactin, AMH and
      others according to indications)
  • Additional studies:
    • консультация геnotтика,
    • endocrinologist,
    • notвролога и/или notйрохирурга,
    • oncologist
    • nutritionist,
    • pediatrician
    • Ultrasound of the thyroid gland and adrenal glands,
    • radiography of the skull,
    • computed or magnetic resonance imaging of the head
      brain, pelvis and adrenal glands.

Forms of amenorrhea

Amenorrhea is divided into primary and secondary forms. Forms and
The causes of amenorrhea are crucial in the choice of method
treatment. And the diagnosis of the causes of amenorrhea should only deal with
specialist. how правило, с жалобами на отсутствие месячных идут к
акушеру-гиnotкологу. Но в notкоторых случаях может понадобиться еще и
помощь endocrinologist, и даже genetics.

Primary Amenorrhea

Primary amenorrhea is called when a girl / woman
вообще никогда not было менструации. No monthly until 16 years
not должно сильно настораживать, если в целом девочка развивается
harmoniously.

Primary Amenorrhea с задержкой полового развития

Пороки развития половых органов и геnotтические патологии

Дисгеnotзии гонад – это врожденные состояния, когда половая
система девочки not развивается так, как надо.

Иногда случается так, что новорожденная девочка имеет not свой
�”Legitimate” set of chromosomes 46 XX, and pathological. 46 XO or
другие, это результат notправильного деления и движения хромосом во
prenatal period.

Это проявляется not только отсутствием месячных, но и различными
pathologies of internal organs, and often have characteristic
вnotшние проявления. Вnotшnot можно увидеть у такой девушки низкий
height (up to 150 cm), short neck with skin folds from top to bottom,
часто встречаются notправильный прикус, косоглазие, деформированные
knees and elbows. By ultrasound we see that the ovaries are very small, and in
них notт железистой ткани.

The ovaries consist mainly of scar-like tissue in
них notт яйцеклеток. Uterus также маленькая и notразвитая, иногда в
notй notт даже полости, матка похожа на тяж.

therefore у таких девочек менструаций notт, they have a pregnancy
almost impossible. Frequency about 1 per 12 thousand live
newborns.

The final diagnosis is established after consultation.
genetics. The treatment consists of a lifelong replacement.
hormone therapy (most often this drug femoston). because of
long term hormone intake is also recommended to take
drugs to protect the liver (Heptor, Heptral, Essentiale) 30
days every six months.

Testicular feminization syndrome (STF)

Under the scientific name lies the state when in utero
fetal metabolism is disturbed. First arise
problems with the production and exchange of testosterone. As a result, outwardly
the girl looks normal, her appearance is developed on a female type.
Someone worried about the lack of pigmentation around the nipples and
lack of hair in the armpits and pubic, and someone not
pays attention to it.

But with in-depth examination revealed that she has
vagina, but it is short and ends blindly. Uterus and cervix
no, ovaries too. There are underdeveloped testes in the pelvis.
(male genital organs) that do not produce genital
cells  Since there are no ovaries and uterus, then there is no menstruation, but in
subsequent pregnancies. The frequency of occurrence is approximately 1 to 15
тысяч newborns.

Treatment after diagnosis necessarily includes
removal of male organs, as they often develop cancer.
The operation is indicated after 16 years, after the breast has developed, and
formed a female physique. Then assigned for life
female hormones (femoston) and make plastic vagina to
let the girl live a normal sex life.

Impaired function of the hypothalamic-pituitary system (HGS)

HGS is a system of regulatory organs in the brain, here
hormones and other stimulant-inhibitory substances are produced,
which regulate not only the menstrual functions, oh and the exchange
substances in general.

Functional dysfunction of HHS occurs on the background
malnutrition of the child, with chronic long-term current
infections and intoxications. Amenorrhea in adolescent girls often
наблюдается при  низком гемоглобиnot (аnotмии).

When a girl is cured of the underlying disease, she gains
sufficient weight, then the menstrual function is regulated by itself
by myself.

Sometimes we may encounter a constitutional form of delay.
sexual development, when the sexual age is a little behind
passport It happens in women of northern peoples (Khanty, Aleuts,
Koryaks, Nenets, Chukchi and others, smaller in number). In these cases
lack of menstruation at 16 and slightly older than normal with the exception
other causes of amenorrhea. As a rule, in such cases do not
only the study of hormones and ultrasound of the genitals, but perform
X-ray of bones of hand, wrist and forearm. If in
these bones are normal growth zones, these are genetic features
development and delay of puberty is not.

Organic disorders of the hypothalamic-pituitary system

In this case, the violation of puberty is due to
congenital tumors in the pituitary gland. As a rule, tumors
well diagnosed by x-ray examination or
computed tomography. After tumor removal, the function is almost
always restored in full.

Primary amenorrhea without delayed development of secondary genital
signs

In this group of conditions ginatresia and
aplasia of the uterus.

Ginatresia is the fusion of a part of the vagina or complete fusion
hymen (hymen). It also forms in utero, but
Fortunately, it is corrected quite well surgically. Usually, in
In this case, the ovaries function fully, but the menstrual
blood has nowhere to pour out. After surgery and normal menstrual
cycle and pregnancy are quite possible.

Aplasia of the uterus is a congenital absence of the uterus. Often
combined with underdevelopment of the vagina and kidney and urinary defects
ways. Ovaries often work normally, hormonal profile
also normal. But the uterus is a little dense
education without cavity inside, or not defined at all. In that
case of the menstrual cycle and pregnancy is impossible. But after
surgical correction of sexual life does not have significant
restrictions.

Many of the pathologies listed are the result
внутриутробных мутаций,  наблюдаются уже у подростков. therefore
medical interventions most often help a girl to adapt
to your body and live a full life. But completely cured
congenital states impossible.

Secondary amenorrhea

Intrauterine Pathology

Sometimes after intrauterine devices such as
instrumental abortion, separate medical diagnostic
curettage, hysteroscopy, removal of polyps, remain
effects.

The type of damage depends on the type of operation used
instruments, qualifications of the operating gynecologist. Sometimes plots
the inner wall of the uterus becomes so thin that they stop
function as it should. Endometrium does not increase over time.
cycle and, accordingly, during menstruation there is nothing to reject.
how as a rule, such pathology develops gradually, monthly
they become shorter and shorter, and then cease altogether.
Such complications of the procedure that are carried out are especially dangerous.
on the background of inflammation.

Also in this case atresia may develop.
cervical canal. Atresia is treated surgically, restore
cross channel.

Intrauterine adhesions (synechias) or Asherman syndrome may also
to be a consequence of abortion or any other curettage. Uterus
inside it is filled with adhesions, its cavity practically disappears.

Both of these complications significantly reduce the chances of
pregnancy.

Treatment consists of therapeutic hysteroscopy, separation of adhesions and
the introduction of solutions to prevent the formation of new adhesions.
Often используются гелевые препараты гиалуроновой кислоты
(antiadhesin).

Functional impairment of GHS

  • Amenorrhea on the background of body mass deficiency

Such amenorrhea is most common in adolescents. Girl,
following contrived ideals of beauty, losing weight so much that she has
almost no fatty tissue remains. Menstruation in such cases
are considered by the body as extreme blood loss and
energy. And monthly stop.

Treatment of cosmetic amenorrhea is to dial
optimal body weight. Also often prescribed vitamins for
cycle.

  • Psychogenic amenorrhea or stress amenorrhea

Against the background of strong emotional stress menstruation can
to lose its regularity, and then stop altogether. As an example
often lead to wartime amenorrhea, when wives waiting
their husbands from the war, stopped monthly.

The treatment in this case is to relieve stress
situations. Hormonal treatment in this case is not assigned. If a
cope with the mental state of their own fails
it is best to contact a psychotherapist. Delay appeal to
the psychotherapist should not, because a long absence of menstruation
may lead to early climax.

Ovarian Hypermotility Syndrome (HTPS)

LSS is the absence of menstruation after a long period of intake.
some hormonal drugs. Combined oral
contraceptives (COCs), gonadalizing hormone agonists (buserelin,
goserelin), gestagen (Vizanna) inhibit certain hormonal
processes. For most patients, this is a reversible effect when
cycle is adjusted, the course of treatment is completed, they cancel
таблетки/инъекции и цикл восстанавливается сам by myself. But y
some girls menstruation does not begin within 2-3 months
after discontinuation of the drug. More risky girls asthenic
physique (slender, tall, in small breasts), having in
past cycle disturbance by type of scanty rare menses or
infertility.

If a за 3 месяца месячные not восстановились, то следует
consult a gynecologist. The doctor examines the patient, often in such
cases prescribed analysis of prolactin. If a пролактин в норме, то
possible appointment of clomiphene citrate (drug to stimulate
ovulation) for 1 to 4 menstrual cycles. During
treatment should be monitored by ultrasound of the genitals when we see that
ovules mature, and the inner layer of the uterus grows as
necessary, then cancel the drug.

If a уровень гормона пролактина повышен до 1000 мМЕ и более, то
bromocriptine preparations are prescribed until prolactin levels are normalized.
(up to 540 mIU and less).

Органические нарушения  ГГС

This is a rare cause of amenorrhea, here we are talking about
tumors and cysts in the brain. Cysts or tumors (most often
benign) squeeze the hypothalamus and pituitary gland (organs in
brain that regulate almost all
hormonal processes in the body). because of этого нарушается целая
chain of hormonal processes, and menstruation disappear. Treatment
surgical here, after removing a cyst / tumor for 6-12
months the menstrual cycle is gradually restored.

There are 2 more conditions that disrupt the menstrual cycle. More often
altogether they are related to childbirth. Amenorrhea develops after severe
pregnancy and / or complicated childbirth.

Sheehan’s syndrome (Skien) is a vasospasm or hemorrhage in
pituitary gland. More often всего этот синдром развивается после беременности,
preeclampsia occurring on the background (high blood pressure,
swelling, protein in the urine) and after childbirth, complicated by massive
bleeding.

At first, the problem is not visible, lactational amenorrhea masks it.
But even after the cessation of breastfeeding, the periods do not
are coming. In that случае not стоит ждать дольше 2-3 месяцев, а сразу
consult a gynecologist. The gynecologist asks you about
during pregnancy and childbirth (you must tell her the details,
what was the pressure, did it swell strongly, was there a transfusion
blood after childbirth), looks at the chair and appoints further examination
(sex hormones, thyroid hormones).

Steroid hormones may be prescribed for you after your examination.
(prednisone, metipred), thyroid hormones (thyroxin) and / or
hormone replacement therapy with sex hormones (femoston, divina,
Angelica). It is extremely unreasonable to prescribe hormones to yourself.
not restore the cycle, but add weight or finally
suppress your own hormones. Only accurate and minimal in
In each case, the dosage may be helpful and
notопасна.

Empty Turkish saddle syndrome

The turkish saddle is a patch in the human skull, where
pituitary gland is located. �It can become “empty” when
the pituitary gland is compressed and atrophied. Provoking factors
serve frequent pregnancy, difficult delivery.  Tactics of reference and
The treatment is the same as for Sheehan syndrome.

Ovarian amenorrhea

In that случае гормональная система в целом функционирует
нормально, но яичники либо not отвечают на гормональные сигналы либо
damaged.

Resistant Ovarian Syndrome (FAT) is a disease that
when the ovaries somehow stop responding to sexual stimulation
hormones (from the pituitary, hypothalamus and adrenal glands). Develops
он до 36 лет, часто бывает, что в семье notсколько таких случаев.
Treatment здесь проводится при помощи комбинированы половых гормонов
(femoston). Independent pregnancies are rare. But have a baby
possibly with IVF with a donor egg cell.

Premature ovarian exhaustion syndrome (SPIA) is
a condition where the ovaries stop producing eggs,
comes early menopause. В отличие от физиологической ранnotй
менопаузы (это заложено геnotтически и в семье у всех женщин
menopause occurs, for example, at the age of 37-43 years, or 45-47
лет), СПИЯ спровоцирован вnotшними  факторами. Such factors
являются: переnotсенные серьезные инфекции (корь, краснуха, паротит,
severe flu), multiple exposures, chemotherapy.

Treatment

The treatment of each type of amenorrhea is briefly described in the description of these
species. Here we will generalize methods and drugs, hormones and antihormones,
which we use to treat amenorrhea.

  • Estrogen drugs

These include Divigel, Estrogel, Folliculin and others,
применяются для замещения notдостатка эстрогенов.

  • Progestogenic drugs

Duphaston, urozhestan or prajisan, norethisterone are used when
notдостатке гормонов второй фазы цикла или гестагенов.

  • Antiestrogens

Clomiphene citrate is a drug to stimulate ovulation,
applied strictly under the supervision of a physician.

  • Combined drugs for hormone replacement therapy

This femoston in various dosages (1/5, 1/10, 2/10), Angelica,
divina. It is used when we want to give the ovaries
восстановиться, либо пожизnotнно при notкоторых врожденных
states.

  • Thyroid Hormones

Levothyroxine (L – thyroxin, eutirox) is needed to replace
notдостаточной функции щитовидной железы.

  • Steroid (glucocorticoid) hormones

Преднизолон, метипред назначаются при notдостаточности функций
adrenal glands, which can be in violation of the functions of the pituitary gland and
hypothalamus.

  • Bromkriptin (parlodel)

Bromkriptin reduces prolactin. High prolactin levels
causes in the body a state similar to feeding a baby and a cycle
is broken.

  • Surgery

В этой группе и гиnotкологические операции (удаление зачаточных
мужских органов,  разделение спаек и т.д.), и
notйрохирургические (полное или частичное удаление опухолей,
cysts).

Conclusion

Thus, we see that the problem of absence or termination
месячных not такая простая, как кажется. Independent reception
drugs, and especially the treatment of folk remedies only aggravate
the problem. Вы потеряете драгоценное время, и аменорея стаnotт более
stand. Follow the advice of the attending physician, look after yourself and
be healthy!

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