Amenorrhea: causes, treatment

Amenorrhea refers to the absence of menstruation for several cycles in women of childbearing age, or the absence of menarche( the first menstruation) in girls aged 16 years. Amenorrhoea is not a separate disease.This is just a symptom that indicates that the woman's physiological changes or serious diseases develop.The task of doctors in such situations is to reveal what exactly triggered the menstrual cycle and choose the right treatment tactics.

Table of Contents: Variety of amenorrhea Causes of amenorrhea Examination of women with amenorrhea Treatment of primary amenorrhea Treatment of secondary amenorrhea

Varieties of amenorrhea

All amenorrhea are divided into two large groups:

• Primary( when menstruation was not at all).
• Secondary, occurring in women who had a normal menstrual function earlier.

In addition, amenorrhea is true and false, physiological and pathological.

With , the true amenorrhea of ​​ in the sex glands, uterus and throughout the body of the woman does not occur cyclical changes, therefore, menstruation does not begin.With

false amenorrhea just all the necessary changes occur, the endometrium is rejected, but does not go outside with menstrual bleeding due to obstruction of the genital tract or hymen.Blood and the torn inner layer of the uterus accumulate in the uterine cavity, fallopian tubes, and the vagina.In such situations, immediate surgical treatment is required.

An example of physiological amenorrhea is the absence of menstruation during pregnancy and lactation.In addition, periodic amenorrhea is not a pathology in the first two years after the menarche( the body needs time to develop menstrual function).Finally, postmenopause is also a variant of physiological amenorrhea.

In turn, pathological amenorrhea is always a result of the influence on the female body of negative factors and a sign of the presence of serious hormonal disorders and diseases.

Causes of amenorrhea

Primary pathological true amenorrhea occurs in girls suffering from:

• Turner syndrome is a congenital pathology in which one X chromosome is absent, which is manifested by a delay in sexual development.
• Abnormalities of the uterus and gonads( there may be complete absence or underdevelopment).
• The syndrome of testicular feminization.In this tissue syndrome are insensitive to male sex hormones, so children who, according to the chromosome set should be boys, are born with external genital organs female and underdeveloped testicles in the abdominal cavity.
• Callman Syndrome.This pathology is manifested by gonadal dysfunction, problems with olfaction and insufficient release of the hypothalamus releasing hormones that affect the ovaries.
• Pathologies of the hypothalamic-pituitary system, in which the release of hormones responsible for the reproductive sphere is reduced or ceases altogether.

Secondary amenorrhea is usually the result of the following diseases:

• Ovarian depletion syndrome( which develops in women under 40 due to autoimmune processes and heredity).
• Polycystic gonads.
• Pituitary diseases( adenoma, hypofunction, etc.)
• Hyperprolactinaemia( increased prolactin concentration in the blood).
• Anorexia.
• Decompensated endocrine diseases( diabetes, hypothyroidism, etc.).

In addition, secondary amenorrhea can occur as a result of strong repeated experiences, chronic fatigue, excessive physical exertion, prolonged hunger and overeating.This is explained simply: the female body is very sensitive to any stressful situations( psychological, physical and even food stresses), therefore responds to them with violent protective reactions.In this case, amenorrhea is an attempt by the body to prevent the conception of a child in conditions that are not suitable for a harmonious development.

Examination of women with amenorrhea

A full-fledged menstrual cycle is one of the main indicators of a woman's health. Therefore, the absence of menstruation without obvious physiological causes( pregnancy, lactation) always indicates a serious malfunction in the body.To address to the gynecologist it is necessary, if a menses is no more than 2 months or there is no menarche at the girl who has reached 16-year-old age.Adult women and mothers of girls should understand that if there is no healthy menstrual cycle, there will be no pregnancy.Most diseases accompanied by amenorrhoea are the cause of female infertility.

Girls and women suffering from amenorrhoea require a comprehensive examination, including:

• Consultation with a gynecologist and endocrinologist( it's best to contact a specialist gynecologist and endocrinologist).
• Investigation of the hormonal profile.
• Pregnancy testing( doctors should make sure that the cause of amenorrhea is not in pregnancy).
• Biochemical blood test( important indicator of sugar in the blood).
• ultrasound of the pelvic organs.
• Radiography of the Turkish saddle, if there is a suspicion that the patient has a pituitary tumor.
• CT and MRI, if there is any indication.
• Samples with female sex hormones, which allow to more accurately determine the cause of amenorrhea.

Treatment of primary amenorrhea

If the girl has an abnormality of the reproductive organs that does not allow menstrual flow out of the genital tract, the surgical procedure is mandatory.The hymen is dissected, the vagina is plasticized, etc.If the girl does not have any other problems with the genital sphere, then after the postoperative recovery the menstrual function usually immediately stabilizes.

In true primary amenorrhea, treatment is more complex, prolonged and not always effective, since it is impossible to restore the ovaries or the uterus, if they simply do not exist.In addition, it matters how timely the disease is detected( primarily it concerns congenital ailments accompanied by hormonal disorders) and treatment is started.

For most pathologies leading to primary true amenorrhea, is indicated for complex hormone therapy .For example, patients with Turner's syndrome have to take estrogen throughout their entire childbearing age.But this gives its results: if it is possible to achieve with the help of hormonal treatment the normal development of the reproductive organs and their readiness for the birth of the child, then it is possible to plan pregnancy( usually IVF with the donor egg).

Replacement hormone therapy for is indicated for both Kallman syndrome and diseases of the hypothalamic-pituitary system.In testicular feminization, in addition to therapy with female sex hormones, before the patient reaches the age of physiological menopause, surgical treatment is also performed( the testicles are removed from the abdominal cavity), but menstruation does not appear in this disease, since the patients do not have a uterus.

In addition, with primary amenorrhea, regardless of its causes, it is very important to pay attention to strengthening the patient's nervous system and balanced nutrition, which provides the body with all the necessary substances.

Treatment of secondary amenorrhea

In secondary amenorrhea treatment usually includes several directions:

• Weight control( weight should be normal, for the reproductive system undesirable both excessive weight loss and obesity is undesirable).
• Restoration of a positive psycho-emotional background.
• Harmonious combination of work and leisure.Therapy of the underlying disease.
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Quite often in gynecology, there are cases when full rest, positive emotions, positive mood and proper nutrition help restore menstrual function without any medication.Therefore, do not ignore the doctor's advice that it is enough to just sleep more, to walk in the air, to drink calming herbal teas, to eat right and have regular sex.

But not everything always develops so smoothly, nevertheless, most pathologies accompanied by secondary amenorrhea have to treat with the help of hormonal drugs. Not be afraid of them.Modern hormonal drugs have a minimum of side effects and maximum effectiveness.

Select the drugs based on the results of the tests and the diagnosis.With ovarian dysfunction, gynecologists prescribe oral contraceptives.With a premature climax( a syndrome of ovarian malnutrition), hormone replacement therapy is indicated.Polycystosis of female gonads is treated with sugar-reducing drugs and again hormones.

If the cause of secondary amenorrhea is in the pituitary tumor, surgical treatment is performed.If hypofunction of this endocrine gland is noted, gonadotypes, gonadotropins are prescribed.In anorexia, the patient is first removed from the severe condition, and only then the hormonal disorders are corrected.

Thus, if amenorrhea is secondary, restore menstrual function and even become pregnant it is quite possible. Just do not delay with a visit to the gynecologist and engage in self-medication.

Zubkova Olga Sergeevna, medical reviewer, epidemiologist-doctor