What is Amenorrhea?
Amenorrhea – the absence of menstruation for 6 months or more. Amenorrhea is the most severe form of the pathology of menstrual function. The frequency of amenorrhea among women of reproductive age is 3.5%, and in the structure of menstrual and reproductive disorders – 10-15%.
Causes of Amenorrhea
There are physiological, pathological, false and pharmacological amenorrhea.
Physiological amenorrhea – the absence of menstruation until puberty, during pregnancy, lactation and postmenopausal.
Pathological amenorrhea – a symptom of gynecological or extragenital diseases, may be primary and secondary.
Primary amenorrhea is the absence of menarche after 16 years, secondary amenorrhea is the absence of menstruation for 6 months in a previously menstruating woman.
False amenorrhea – the absence of blood secretions from the genital tract due to the violation of their outflow due to atresia of the cervical canal or a malformation of the genitals. In this case, the cyclic activity of the ovaries is not disturbed, endometrial rejection occurs.
Pharmacological amenorrhea is associated with medication (gonadotropin agonists, anti-estrogen drugs), the effect of which leads to the absence of menstruation during treatment and is reversible.
Depending on the predominant level of damage to one or another link in the neuroendocrine system, hypothalamic, pituitary, ovarian and uterine forms of amenorrhea are isolated; amenorrhea, caused by pathology of the adrenal glands, thyroid gland, extragenital diseases.
Secondary amenorrhea – the absence of menstruation for 6 months or more after a period of regular or irregular menstruation, is up to 75% of cases of amenorrhea. Amenorrhea is considered secondary even with one menstruation in history. Secondary amenorrhea often becomes a symptom of dysfunction of the ovaries, adrenal glands, pituitary, thyroid and is not combined with a violation of the development of secondary sexual characteristics.
Functional or organic disorders at any level of complex regulation of the menstrual function can cause secondary amenorrhea. Depending on the level of damage to the reproductive system, the following syndromes and diseases are distinguished:
- Amenorrhea hypothalamic genesis
– amenorrhea on the background of weight loss
– psychogenic - Amenorrhea of pituitary genesis
– hyperprolactinemia
– hypogonadotropic - Amenorrhea of ovarian genesis
– ovarian exhaustion syndrome
– resistant ovary syndrome
– virilizing ovarian tumors - Uterine form of amenorrhea
– intrauterine synechia (Asherman syndrome) - False amenorrhea
– atresia of the cervical canal - Amenorrhea in diseases of the adrenal glands and the thyroid gland.
Amenorrhea hypothalamic genesis
Amenorrhea on the background of weight loss is accompanied by a persistent desire to lose weight, weight loss by 15% or more. In the structure of secondary amenorrhea, this pathology is about 25% and is common among adolescent girls who exhaust themselves with diet and exercise in order to maintain low body weight. An extreme form of weight loss with appetite distortion is observed in anorexia nervosa. Forced vomiting and the abuse of laxatives can be fatal.
Pathogenesis during Amenorrhea
Sharp weight loss leads to a change in the daily rhythm of gonadotropic hormone secretion due to impaired neurotransmitter metabolism of the central nervous system. The levels of gonadotropic hormones are either constantly low or they increase during sleep. Adipose tissue plays a definite role: the rapid loss of 10-15% of adipose tissue during puberty or postpubertal period leads to an abrupt cessation of menstruation.
Symptoms of Amenorrhea
The absence of menstruation – one of the very first signs of the onset of the disease – leads the girls to the gynecologist. On examination, a sharp decrease in the subcutaneous fatty tissue is noted with a female body type. Secondary sexual characteristics are developed normally. Gynecological examination shows moderate hypoplasia of the external and internal genital organs. Continued weight loss leads to an increase in fasting symptoms – bradycardia, hypotension, hypothermia. Further, irritability, aggressiveness, cachexia with complete loss of appetite and aversion to food appear. This may be the beginning of a mental illness – anorexia nervosa.
Diagnosis of Amenorrhea
Active survey allows you to identify the chronological coincidence of weight loss and the beginning of amenorrhea. The decrease in the level of gonadotropic hormones to the lower limit of the basal values is determined during hormonal studies. Consistent hormonal testing allows you to identify the reserve capabilities of different levels of the reproductive system.
Amenorrhea Treatment
Treatment includes correction of psycho-emotional disorders, overcoming stressful situations, adequate, easily digestible nutrition, and vitamin therapy. The need for the use of psychotropic drugs determines the neuropsychiatrist, consultation of which is necessary with the persistent refusal to write. Restoration of menstrual function is possible after normalization of body weight and discontinuation of psychotropic drugs that suppress the pituitary gonadotropic function. In the absence of effect, cyclic hormone therapy with natural estrogens and gestagens for 3-6 months is indicated.