• Amenorrhea - Causes, symptoms and treatment. MF.

    Amenorrhea is the absence of menstruation.

    Amenorrhea can be a sign of gynecological, neurological and endocrine diseases, but it can be a variant of the norm. Amenorrhea should be considered as a normal physiological condition in the following cases: during pregnancy, lactation, until puberty( that is, until the timing of the recurrence of menstrual flow in the girl), and after menopause( after 45 years).In all other cases, amenorrhea is a pathology.

    Amenorrhea happens:

    - primary - no signs of puberty and menstruation in a girl at age 14, or the presence of signs of puberty( enlargement of the mammary glands, growth of pubic hair and in the armpits), but the absence of menstruation up to 16 years;
    - secondary - the termination of menstruation in a woman with a fixed menstrual period of more than 6 months.

    Causes of amenorrhea

    Causes of primary amenorrhea:

    - genetic abnormalities;
    - disruption of the pituitary, hypothalamus and brain, ie, a cyclic link in the hypothalamic-pituitary system that regulates the menstrual cycle( hypothalamus-pituitary-ovary-uterus);

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    - anatomical impairment of genital organs( absence of uterus, vaginal or cervical infection, absence of a hole in the hymen, etc.).This leads to a "false amenorrhea", in which the ovaries are perfectly functioning, the menstrual cycle is settled, but there are obstacles to the exit of the menstrual blood to the outside.

    Hypothalamic-pituitary system regulating the menstrual function of

    Possible causes of secondary amenorrhea:

    - heavy physical exertion, in particular, this applies to professional athletes;
    - malnutrition - craze for mono-diets( consumption of only one type of product), sudden weight loss, anorexia( aversion to food);
    - thyroid disease - hypothyroidism, thyrotoxicosis;
    - tumors of the pituitary gland - prolactinoma( a benign tumor that leads to an increase in the hormone prolactin in the blood);
    - ovarian diseases with endocrine disorders: polycystic ovary syndrome, resistant ovarian syndrome, depleted ovary syndrome, various ovarian tumors;
    - cramping of the vagina, cervical canal, fusion in the uterine cavity cause a false secondary amenorrhea;
    - psychological problems, severe stress.

    Photo Polycystic ovary syndrome

    Symptoms of amenorrhea

    Symptoms of the disease are expressed, as already mentioned, in the absence of menstruation. As a consequence, the reproductive function is impaired, infertility occurs. Infertility and lack of menstruation are the main and permanent symptoms of the disease, characteristic of all kinds of amenorrhea. All other symptoms are more specific and characteristic of a certain type of amenorrhea.

    With false amenorrhea caused by anatomical disorders, for the accumulation of menstrual blood in the uterus, cramping pains appear in the abdomen on the estimated days of menstruation, which last about 2-3 days. In parallel with this, the patient may be disturbed by headaches, nausea, and enlargement of the mammary glands.

    In amenorrhea caused by tumors of the pituitary gland, the main symptoms are galactorrhea( the flow of milk from the mammary glands), neurological symptoms-irritability, headaches, emotional instability.

    Primary amenorrhea with genetic abnormalities determines underdevelopment of the genital organs. Girls with a similar pathology are disproportionate - high growth, long arms and legs and short body.

    In secondary amenorrhea due to endocrine disorders, "climacteric symptoms" at a young reproductive age may be troubling - hot flashes, permanent weakness, pain in the heart. Patients with polycystic ovaries are characterized by obesity and increased insulin levels in the blood, as well as excessive body and face hair.

    With signs of amenorrhea, if this does not apply to the options for the norm, consultation and a detailed examination with a gynecologist is necessary.

    Diagnosis of amenorrhea

    Diagnosis of amenorrhea includes:

    - examination of the gynecologist on the chair;
    - ultrasound of pelvic organs;
    - blood test for hormones( necessarily check the level of hormones FSH, LH, E2, Prl, with polycystic ovaries additionally check the level of free Tst);
    - blood test for thyroid hormones( TTG, T4, T3);
    - biochemical blood test with determination of glucose level, with obesity and polycystic ovary syndrome necessarily a test for glucose tolerance;
    - if a pituitary tumor is suspected-neurologist consultation is required, skull X-ray is displayed with visualization of the Turkish saddle, CT and MRI of the brain;
    - if necessary, hormonal tests with gestagens, estrogens or clomiphene are performed with endocrine abnormalities of the ovarian function;
    - in primary amenorrhea, a karyotype( the structure of the sex chromosomes) is determined;
    - in the presence of fusion in the uterine cavity, according to ultrasound, hysteroscopy( examination of the uterine cavity with a hysteroscope) is shown;
    - diagnostic laparoscopy is indicated for polycystic ovary syndrome.

    The volume of diagnostic tests is determined by the doctor-gynecologist after examination and detailed collection of the patient's medical history.

    Treatment of amenorrhea

    The tactics of amenorrhea treatment depend on the form and severity of the disease. For all types of amenorrhea, prolonged hormone replacement therapy( HRT) is prescribed to stimulate normal ovarian function.

    The group of drugs used to treat amenorrhea:

    - estrogens( Proginova, Folliculin, Divigel, Estrofem) - are suitable for women with endocrine disorders of ovarian function and girls with delayed puberty( if there is no neurological pathology);
    - gestagens( Norkolut, Pregnin, Dufaston, Utrozestan) - are widely used in both primary and secondary amenorrhea;
    - analogs of gonadotropin-releasing hormones GnRH( Cyclomat) - is used to treat patients with polycystic ovary syndrome to induce ovulation and help a woman become pregnant. This group is also used to treat primary amenorrhea caused by disorders of the hypothalamic-pituitary system;
    - combined estrogen-gestagen oral contraceptives( COCs) are prescribed for polycystic ovary syndrome. Preference is given to COCs with an antiandrogenic effect( Janine, Diane-35);
    - synthetic non-steroid drugs - anti-estrogens( Clomifene) - used to treat infertility in women with secondary amenorrhea, the drug causes ovarian hyperstimulation.

    Duration of treatment with hormones varies depending on the specific situation. In some cases, hormones can be prescribed by courses, in others, drugs are prescribed until the age of menopause.

    In parallel with hormone therapy with a confirmed diagnosis, you can independently apply homeopathic herbal remedies( Remens, Klimadinon, Mastodinon) - they regulate the hypothalamic-pituitary system, normalizing the menstrual cycle. In addition, the drugs have a sedative effect. Good tolerability and a minimum of side effects allow the use of drugs for a long time.

    In addition to hormonal and homeopathic therapy, certain forms of amenorrhea require surgical treatment. First of all, this refers to amenorrhea caused by neurological pathologies, for example, a pituitary tumor. After a preliminary examination of the neurosurgeon, the indications are hypophysectomy( surgical removal or destruction of the pituitary gland) or radiotherapy is prescribed. Only after this hormonal therapy is carried out.

    In case of false amenorrhea caused by fissures in the uterine cavity, the cervical canal is also necessary for surgical intervention. On the prospective day of menstruation, a hysteroresectoscopy is performed( the seizures run out).Next, hormone therapy is prescribed-estrogens and gestagens cyclically.

    For the treatment of infertility, patients with polycystic ovary syndrome are shown laparoscopy - a microsurgical method, which is the most effective method for stimulating ovulation. During the operation, the changed parts of the ovaries are removed( "wedge resection" of the ovaries).After surgery, pregnancy occurs in approximately 70% of patients.

    With regard to patients who have amenorrhea due to functional impairment, that is, a sharp decrease in weight or excessive physical and stressful loads, in this case, the treatment should be aimed at eliminating the provoking factor, after which the menstruation is restored independently. If this does not happen, then hormones are prescribed. For a full normal menstrual function, it is necessary that the weight of the woman is not less than 44-46 kg.

    It is important to observe a certain lifestyle for a speedy recovery. In amenorrhea caused by endocrine disorders, patients with high body weight are recommended diet and exercise. In polycystic ovaries, this is especially important, since the increased weight further aggravates the hormonal disorders, and can lead to early development of diabetes mellitus, hypertension and atherosclerosis, not to mention the fact that the treatment may not be quite effective.

    Fully eat and rest! Try to eliminate negative emotions. If amenorrhea has arisen because of the strong stress, it is not superfluous to visit a psychotherapist.

    In the rehabilitation period it is useful to combine hormonal therapy with physiotherapy, which allows to regulate normal metabolism and normalizes the menstrual cycle. Apply endonasal electrophoresis of novocaine, zinc, thiamine. Electrophoresis on the collar and on the cervico-facial zone with vitamins is useful, thereby direct effect on the hypothalamic-pituitary region and the function of the nerve centers is regulated.

    Treatment of amenorrhea folk remedies

    In folk medicine, there are many recipes for infusions to combat amenorrhoea. Before applying any folk prescription, you need to make a pregnancy test and exclude it.

    The most popular of the folk remedies for amenorrhea and recipes available to the average person:

    - 3 tablespoons of chopped parsley are brewed in a half liter of water and left in a thermos for 10-12 hours. Then the broth is passed through a sieve and taken 3 times a day for half a glass a day before meals. The broth should drink about 3 weeks for better effect;
    - peel the onion on low heat until darkening the water. After cooling, let it pass through a sieve. Take half a glass before meals 3 times a day.

    Folk remedies can have a very good effect, especially with amenorrhea caused by psychological factors, but unlike hormones, they only alleviate the symptoms of the disease and have a temporary effect without eliminating the underlying cause of the disease. Therefore, the gynecologist in any case, you have to go, and tinctures can be used only as an additional tool.

    Complications of amenorrhea:

    - infertility and menstruation disorders that can not be treated. In this connection, it is often necessary to resort to assisted reproductive technologies - in vitro fertilization( IVF), insemination with the husband's semen or induction of ovulation. In severe cases, if you want to have a child, you resort to surrogate motherhood;
    - early development of "age" extragenital diseases due to estrogen deficiency( osteoporosis, cardiovascular disease, diabetes mellitus);
    - a high risk of developing endometrial cancer and hyperplastic processes in the uterus;
    - Pregnancy in women with amenorrhea caused by endocrine disorders often causes miscarriages at an early age, premature birth, diabetes of pregnant women, signs of pre-eclampsia
    ( high blood pressure, protein in the urine, etc.).

    Prevention of amenorrhea

    - regular visit to the gynecologist;in the presence of concomitant diseases of the endocrine or nervous system, a dynamic observation in the endocrinologist or in a neuropathologist;
    - a healthy lifestyle: regular exercise, a balanced diet, especially this is true during sexual development, maintaining a normal weight, eliminating stressful situations;
    - regular sex life.

    Questions and Answers.

    1. I had a period of 14 months after a sharp weight loss. She gained weight, the men appeared again. Now I want to get pregnant, but I can not. Can this be a consequence of amenorrhea?
    Every woman has a chance to become barren, this is not necessarily related to amenorrhea in the past. Another thing is a sudden, causeless weight loss - it can talk about the presence of endocrine diseases, which do not allow you to become pregnant. You need to turn to a gynecologist if you can not get pregnant within one year of a regular sexual life without protection.

    2. I started my period, but the next day it stopped, after that, there is no month for a month. What could it be?
    Take a pregnancy test, this may indicate a threat of miscarriage at an early age or ovarian dysfunction. In any case, you need to go to the gynecologist.

    3. How long does amenorrhea last after delivery?
    Depends on whether you are breastfeeding a baby. In non-breastfed women, the menstrual cycle can be restored after 6-8 months, and in nursing in a few months or even a year. This all is a variant of the norm.

    4. I am 38 years old, already a month old no. Symptoms of menopause do not bother, I do not want to give birth. Do I need to be treated?
    To be treated it is necessary. Early menopause can lead to serious illnesses.

    5 .I have polycystic ovary syndrome. I have been unsuccessfully treated for infertility for several years with hormones, but there is no effect whatsoever to do?
    Most likely, you are shown surgical stimulation of ovulation or it is necessary to resort to artificial insemination. In any case, your physician should determine the treatment tactics.

    6. I am 16 years old, and there is still no menses. Can I have sex?
    It is possible, but it is also necessary to visit a gynecologist and find out the reason for the absence of menstruation.

    7. Can amenorrhea be from a prolonged intake of hormonal contraceptives?
    Yes, it can. This is a rare side effect of hormonal contraceptives, when the syndrome of hyper-inhibition of the ovaries develops. It is necessary to stop taking hormones, the menstrual function will be restored on its own several months after cancellation.

    8. Can I get pregnant during lactation if there are no menstruation?
    Lactational amenorrhea is an unreliable method of contraception, so pregnancy is possible, even if you do not yet have menstruation.

    Obstetrician-gynecologist, Ph. D.Christina Frambos.