The delay is monthly, the test is negative: what should I do?

The delay in menstruation may be different, as are the causes that cause it.

All kinds of this pathology are a manifestation of hypomenstrual syndrome, which is also accompanied by a violation of the reproductive function.

Therefore, without qualified medical help a doctor can not do and the sooner the treatment is started, the more effective it will turn out.

Causes of delay in menstruation - negative test

It is common to distinguish several manifestations of the delay in menstruation, depending on the duration of this condition:

1. 1) Oligomenorrhea is a situation in which menstruation is absent for 2-4 months.
   
2. 2) Opsomenorrhoea - no monthly for 4 to 6 months.
   
3. 3) Amenorrhea - menstruation is absent for more than 6 months.

Amenorrhea can be either primary( there was no menstruation, that is, there was no menarche), and secondary( cessation of pre-existing menstruation).Norma menarche( first menstruation) should occur before the age of 16, otherwise it will be regarded as amenorrhea.


At the heart of the secondary disorder of the menstrual cycle lie the acquired pathological processes.

So, the main diseases that predispose to primary amenorrhea are:

• inadequate production of gonadotropic hormones;
  
• alimentary failure of pituitary function deficiency;
  
• hypercortisy puberty;
  
• hyperprolactinaemia;
  
• agenesis( absence) of gonads;
  
• dysgenesis of the genital organs of the girl;
  
• polycystic ovaries;
  
• refractory ovarian syndrome;
  
• congenital disorder of the adrenal cortex;
  
• atresia of the cervical canal or vaginal tube.

The causal factors for the discontinuation of the monthly ones, which were before, are:

• hyperprolactinemia functional;
  
• pituitary adenomas, which secrete prolactin;
  
• Neuroendocrine Syndromes;
  
• hyperandrogenia of ovarian or adrenal origin;
  
• depleted ovaries;
  
• resistant ovaries;
  
• Asherman's syndrome - the presence of adhesions in the uterine cavity;
  
• is an endometritis chronic;
  
• hypothyroidism, which again involves the genital organs in the pathological process.

As you can see, the reasons for the delay of the monthly, if the test is negative, can be a large number, and most to make a diagnosis, and decide what to do you will hardly succeed.

Delay of menstrual, except pregnancy

The following factors can cause delay in menstrual periods with a negative test:

1. 1) Violation of the normal anatomical structure of the genital organs( for example, atresia of the cervical canal, which complicates the outflow of menstrual blood).
   
2. 2) Endocrine diseases, which involve not only the sex glands, but also the other endocrine glands, in the pathological process.
   
3. 3) Various diseases of internal organs( in the first place it is worth noting the pathology of the liver).
   
4. 4) The effects of various pharmacological drugs that can disrupt the operation of the finely controlled system of the hypothalamus-pituitary-ovaries. Especially the reception of contraceptives.
   
5. 5) Negative impact of environmental factors.

What should I do if my menstrual period is delayed?

Before deciding what to do, it should be remembered that a negative pregnancy test and a delay in menstruation does not mean that there is no pregnancy. Therefore, the diagnosis of delay in menstruation should begin in the first place with the exclusion of pregnancy.

For this, the following studies are recommended:

• vaginal - determined by the enlarged uterus, cyanosis of the cervix;
  
• determination in the blood of the level of chorionic gonadotropin and its comparison with the proper level for a given period of pregnancy;
  
• urinary gravity test( it is considered positive when two strips are determined);
  
• ultrasound, including with the exception of ectopic pregnancy.

In the case when the delay of the monthly is primary, that is, there was no menarche, the diagnostic search is constructed as follows:

1. 1) The doctor finds out by vaginal and ultrasound examination whether the girl has a uterus;
   
2. 2) If not, then karyotyping, that is, determining the genetic sex of the child, is performed. The karyotype, which corresponds to the female, speaks of the presence of the Rokytansky-Kyustner syndrome. He is an indication for a geneticist's advice. If the male genotype is diagnosed in the presence of female genital organs, then this situation is regarded as a testicular feminization syndrome. In this case, surgery is shown, during which the sex glands are removed. This is also dictated by the fact that these patients have a higher risk of developing genital cancers. To restore hormonal balance and improve the appearance, hormone replacement therapy is prescribed by estrogen-gestagenic drugs.
   
3. 3) If the uterus is present, then its size is estimated using ultrasound. Depending on this, all patients are divided into three main groups - with normal size of the uterus, with reduced and enlarged uterine sizes.
   
4. 4) Increasing the size of the uterus requires the exclusion of the following conditions - pregnancy, a hematometer( blood accumulation in the uterine cavity) or an ovarian cyst with hormonal activity. Depending on the diagnosis, treatment is also performed( bougie cervical canal with hematometer, hormone therapy with ovarian cyst)
   
5. 5) At normal uterine size, the thickness of the endometrium( inner layer of the uterus) is measured by ultrasound. If it is thicker than 8 mm, then only observation is carried out, if up to 8 mm - cyclic vitamin therapy is performed.
   
6. 6) Reduced size of the uterus requires the exclusion of a number of genetic syndromes.

Secondary delay of the monthly is also an indication for immediate treatment to the gynecologist. He also conducts a purposeful differential-diagnostic search using the following algorithm:

The first step is to perform a progesterone test. To this end, the patient is assigned a gestagen, for example, Dufaston, one tablet for 10 days. The sample is considered positive if after the last pill 3-7 days later menstruation begins. Otherwise, it is negative.

With a negative sample, the definition of a follicle-stimulating hormone in the blood is shown. When it decreases, hypopituitarism is diagnosed - a decrease in the function of the pituitary gland. The rise of this hormone is a sign of either depleted or resistant ovaries. The normal value of follicle-stimulating hormone is an indication for carrying out an ultrasound.

Positive test with progesterone indicates the presence of endocrine pathology. To detect it, the levels of the main hormones in the blood are determined. An increase in the thyroid-stimulating hormone and a decrease in thyroxine and triiodothyronine is a sign of hypothyroidism, an increase in prolactin is a sign of hyperprolactinaemia, an increase in adrenocorticotropic symptoms is a sign of hypercorticism, a rise in testosterone is a sign of hyperandrogenism.


Operation is subject to availability:

1. 1) Developmental anomaly;
   
2. 2) Adhesive process;
   
3. 3) Tumors, etc.

However, in most cases, hormonal treatment is indicated, which depends on the form of the endocrine pathology. Thus, with a decrease in the function of the ovaries and hypothyroidism, hormone replacement therapy is performed. Hypercortisies require the administration of inhibitory therapy, etc.

Possible complications due to

delay The main complication, which can develop against the backdrop of a delay in the monthly, due to the pathological process, is its progression. After a certain time, this leads to irreversible consequences in the reproductive system.

In addition, the ability to fertilize and bear a child is impaired( see infertility treatment in women).Therefore it is very important to contact the gynecologist in due time in the presence of various violations of the ovarian-menstrual cycle.

Prevention

Prevention of delay in menstruation is to comply with the following recommendations:

• exclusion of negative factors during pregnancy;
  
• rational nutrition;
  
• moderate physical exertion( in contrast to the athletes who train naznos, there is amenorrhea);
  
• taking only necessary medications that are prescribed by a doctor, etc.

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