Amenorrhea: causes, treatment, signs, symptoms

What is it - if women 16-45 years have a menstruation disorder and there is no menstruation for six months, diagnose amenorrhea.

It is not isolated into a separate disease, because it arises as a symptom against the background of disorders: physiological, psychoemotional, biochemical and genetic.

The majority of women are mistakenly perceived as the norm of violation of the cycle of menstruation. Therefore, for them, the delay in menstruation is not an occasion to visit a gynecologist even in the presence of pathological excretions and discomfort, lower abdominal pains.

With too long delay in menstruation, women start using tests to check their pregnancy and take a wait-and-see attitude, which leads to infertility and other complications.

Classification of

The basis of classification is two types of amenorrhea - false and true.

If hormonal and cyclic changes are preserved in the uterus and ovaries, amenorrhea is called false, since there are no menstrual discharge from the genital tract due to anatomical obstructions. In the absence of ovulation, amenorrhea is diagnosed as true, because for this reason a woman can not become pregnant.

Amenorrhoea false

False amenorrhea occurs in the case of a congenital malformation of the genitals: atresia of the virgin pleura( hymenal opening), vagina or cervix. Therefore, blood accumulates during menstruation in the area of ​​the vagina( with gelmatolkopolis), the uterine cavity( with a hematometer) and in the fallopian tubes( with hematosalpinx).

Amenorrhea true

There are no menstruation and ovulation with true amenorrhea on the background of the cyclic processes of the body, so a woman can not conceive a child. True amenorrhea is divided into: physiological and pathological, which depends on its causes.

In amenorrhea, the physiological true is absent from the monthly:

• in girls - before puberty;
  
• in women - during pregnancy and lactation while breastfeeding;
  
• in elderly women - during menopause.

Lactational amenorrhea

Lactational true physiological amenorrhea is 98% effective as a physiological contraceptive method for only six months after delivery during breastfeeding. Thus it is necessary to observe such rules:

• to feed the child not less than 6 times a day;
  
• breast-feed at night;
  
• not to use mixed feeding and lure, so that the child sucks constantly mother's milk.

During this period there will be no menstruation and another pregnancy. The benefits of such nutrition for the newborn is obvious. Mom can recover during this time after childbirth. The disadvantage of lactational amenorrhea is the lack of a guarantee of protection against penetration into the genitals of infectious and venereal diseases, including HIV and B-hepatitis.

With pathological true amenorrhea there are no monthly if there are violations: organic or functional in the body of a woman:

• of endocrine diseases;
  
• of the nervous system;
  
• pathological shocks;
  
• of infantilism.

Amenorrhea pathological true is divided into primary and secondary.

Amenorrhoea primary

If there is no menstruation initially( delayed sexual development) in adolescent girls, the amenorrhea is found to be primary.

Amenorrhea secondary: causes of

If there are reasons for stopping menstruation, note amenorrhea secondary. It can be mental and disorders of the hormonal system or digestive tract, gynecological diseases.

The cause of diseases associated with gynecology are:

• tuberculosis of genital organs;
  
• surgery for removal of the uterus and ovaries;
  
• abortion;
  
• ovaries after exposure to radioactive radiation;
  
• presence of acute infectious diseases;
  
• the presence of chronic diseases that cause malnutrition: typhoid, malaria and pulmonary tuberculosis;
  
• chronic poisoning with phosphorus, mercury and lead.

Most often, amenorrhea secondary is hypothalamic, which is divided into subspecies:

• is psychogenic due to strong mental stress;
  
• Chiari-Frommel Syndrome;
  
• false pregnancy of a mental nature;
  
• intoxication;
  
• nervous( prolonged voluntary starvation);
  
• adiposo-genital dystrophy( the hypothalamic-pituitary region is disrupted);
  
• syndrome by Lawrence-Moon-Biddle.

Also true pathological secondary amenorrhea can be: uterine, ovarian and pituitary. With these types of secondary pathology changes occur in the sexual and urinary system of women. They disrupt the work of other internal organs of the female body.

Diagnosis of amenorrhea

During admission, the doctor excludes pregnancy and clarifies the points that triggered secondary amenorrhea. It could occur in connection with the infatuation with various new-fashioned diets, mental and physical overloads, concomitant diseases, the coincidence of the onset of menopause with a grandmother or mother.

Determine the height and weight of patients and correlate indicators with the norm, because as a result of dystrophy or obesity there is amenorrhea due to physiological and hormonal failures.

The doctor determines the degree of abnormal ovarian function, examines the urogenital organs with ultrasound. The presence of hormones( E, LH, FSH and prolactin and thyroid gland - T3, T4, TTG) is determined by the analysis of blood.

To determine free testosterone and polycystic laparoscopic examination. Tolerance to glucose is determined by tests.

Women undergo a examination with a neurologist. To exclude suspicion( or confirmation) in the pituitary gland of the tumors, x-ray of the skull or computer( magnetic resonance) tomography is performed.

Hormonal assays, the use of gestagens and estrogens give a picture of endocrine disorders of ovarian function. The smear of the vaginal contents is studied and the estrogen saturation of the organism and the presence( absence) of infections are determined. Explore the microflora of the vagina along with the epithelium of the uterus.

In amenorrhea, uterine zoe will be slightly opened, and it will contain a small amount of mucus, which differs from the normal course of menstruation 6-20 days. The external cervical cervix should normally be enlarged and filled with a clear liquid, so when viewed it is similar to the pupil of the eye.

Treatment of amenorrhea primary

In the presence of primary amenorrhea, the factors that cause it are eliminated or corrected. To do this:

1. 1) With Turner syndrome - hormone replacement therapy( extrogenation) for life;
   
2. 2) Girls in the case of delayed reproductive and physical development - the buildup of fat and muscle mass through diet, hormonal treatment under the supervision of a gynecologist and endocrinologist;
   
3. 3) In the presence of anatomical causes of primary amenorrhea - surgical operations to remove obstacles and create conditions for a normal outflow of menstrual blood along the genital tract from the uterus to the outside;
   
4. 4) Strengthen the nervous system with appropriate treatment;
   
5. 5) Exclusion of such power sports as weightlifting, bodybuilding and single combat;
   
6. 6) The abolition of various diets, due to which the body does not receive enough protein, fat and vitamin and minerals.

Treatment of amenorrhea secondary

In the presence of amenorrhea secondary, the cause of amenorrhea is clarified and eliminated. Patients should follow all doctor's recommendations:

1. 1) To observe a full and healthy diet, a mode of work and rest, to exclude stressful situations, to be engaged in physical culture.
   
2. 2) Effectively treat common infectious and somatic diseases.
   
3. 3) Eliminate toxic compounds from the body by purifying the body
   
4. 4) Maintain a basal temperature chart to detect ovulation.

The treatment provides for hormonotherapy for a long time to stimulate the work of the ovaries, treatment with gestagens. With polycystic ovaries appoint the appropriate drugs. Stimulation of ovulation is carried out with the help of analogues of gonadotropin-releasing hormones.

Combined estrogen-progestational oral contraceptives eliminate polycystic ovary syndrome. With polycystic ovaries, laparoscopy is used: the altered parts of the ovaries are removed through small punctures in the abdomen.

Hormonal drugs are prescribed simultaneously with homeopathic remedies - Remens and Mastadinone for regulating the hypothalamic-pituitary system and normalizing the menstrual cycle.

Surgically excised the acquired anomaly - fusion in the cervical canal or uterine cavity by carrying out a hysteroresectoscopy on the prospective day of the onset of menstruation.

Complications of

Prolonged amenorrhea with a low estrogen content in the blood leads to the presence of:

• hot flushes;
  
• of vaginal dryness;
  
• dyspareunia( painful intercourse);
  
• atrophic colpitis;
  
• of osteoporosis;
  
• infertility.

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