An important indicator of female health in reproductive age is the regularity of the ovarian-menstrual cycle. With deviations in one direction or another, legitimate questions arise about violations of the health of the female sexual sphere, the most serious consequence of which may be infertility.
Causes and symptoms of amenorrhea
The complete absence of cyclic menstrual bleeding for a long time (more than 6 months) is a gynecological disease and is called amenorrhoea. The female organism is a fairly volatile system and the impact of various external and internal factors on it during certain life periods can have a significant effect on the activity of the endocrine glands, the course of biochemical reactions, metabolic processes, the psychoemotional sphere, and lead to unexpected reactions manifested by amenorrhea as well.
Amenorrhea in a woman who has reached pubertal age, often serves as a cause for concern. But is this always justified? In most cases, of course, the absence of menstruation signals a serious illness requiring immediate treatment. But also some manifestations of physiological conditions caused by functional changes in the female body under the influence of hormones - own or coming from outside with medications can lead to amenorrhea.
For reasons of origin, several types of amenorrhea are distinguished: false and true. False, as the name implies, does not involve violations of the cyclicity of the hormonal background. Months at the same time occur according to the schedule, but there is no allocation. The cause is any obstacle in their way along the genital canal. Most often, this type of amenorrhea occurs with congenital malformation of the vagina and hymen - atresia (adhesions), which is quite simply removed surgically. In the absence of violations in the hormonal sphere, ovaries and other genital organs, the absence of cyclic menstrual bleeding is called true amenorrhea.
Depending on the mechanisms of development, physiological and pathological amenorrhea is isolated. The processes leading to a true physiological amenorrhea are considered to be absolutely natural.
With physiological amenorrhea, there are no organic changes in the body of the woman, the causes of its appearance are hormonal. Knowledge of the peculiarities of the functioning of the female endocrine system allows you not to worry about not the onset of menstruation at the indicated time at the following conditions:
- Physiological amenorrhea is noted during pregnancy and for several months after childbirth during breastfeeding. Ovarian hormones (progesterone) and pituitary gland (prolactin) responsible for the preservation of the fetus, its bearing in due time, the formation of milk in the mammary glands and the reverse development of the uterus in the postpartum period are responsible for this process.
- women in menopause also lack menstruation. This is a physiological phenomenon associated with the age-related extinction of the childbearing function and the gradual cessation of the hormonal activity of the ovaries. In the climax, the female reproductive system, as it were, undergoes a process of reverse development, the natural outcome of which is the onset of amenorrhea.
- Children's age before the onset of menarche (the first menstrual bleeding) is also considered one of the varieties of physiological amenorrhea.
- Stressful for the body situation can also lead to fluctuations in the level of female hormones in the blood, stopping periodic bleeding for a long time. A strong psycho-emotional shock, anxiety, chronic fatigue and even a banal change in the climatic region can lead to the development of psychogenic amenorrhea.
External factors, seemingly not having any relation to the functioning of the reproductive system, in fact can have a serious impact on the female body. Their action is all the same through the same change in the hormonal background and the amenorrhea caused by them can be called conditionally physiological.
- modern life with its unreasonable requirements for female beauty often forces the fair sex representatives to literally mock their bodies, leading them to fainting with diets and physical training. At best, this is fraught with the termination of menstruation. In the worst - severe mental disorders and irreversible changes in the condition of internal organs. Constantly slimming girls and women should remember that subcutaneous fat is a kind of depot for female sex hormones - estrogens, and with loss of its mass below 22%, menstruation will remain only a memory.
- professional athletes, as well as women engaged in heavy physical labor, often suffer from amenorrhea. Constant stress, disproportionate exercise, low-calorie diet, non-observance of the daily routine, constant travel and flights require the mobilization of all forces. The organism understands that such conditions of existence are incompatible with the bearing of pregnancy and includes protective mechanisms - the ovarian-menstrual cycle freezes. There comes sport amenorrhea.
- hormonal contraceptives can promote the development of amenorrhea, not only during their use, but even after some time after stopping the intake. This is due to the inhibition of pituitary production of its own hormones by gestagens contained in contraceptives. In the absence of diseases of the pituitary and ovaries, cyclic bleeding recovers within a few months after drug withdrawal. If this does not happen, you should contact a gynecologist and undergo a detailed examination of the body.
- severe chronic and infectious diseases leading to exhaustion of the body, postoperative conditions, dysfunction of the thyroid gland can also cause the termination of menstruation. In this case, treat the underlying disease, which has nothing to do with the reproductive system.
With such changes, the absence of menstruation is a consequence, not a cause, and in some cases requires detailed examination and treatment of concomitant pathology.
Pathological amenorrhea develops due to various organic or functional disorders, and most often due to their combination, at any level of the female's reproductive system. This condition is already not just a temporary disorder, but an independent disease and serves as a reason for referring to a specialist. The primary and secondary amenorrhea are distinguished by the depth of reproductive disorders.
Types of primary and secondary amenorrhea:
- The uterus.
About primary amenorrhea can speak in the event that the girl at the appropriate age does not come menarche. There are quite a few reasons for this state, but it is still quite rare. Most often there is a genetically determined incompetence of the ovaries and the monthly ones occur at a rather late age - after 17 years. Otherwise, if the menstrual period does not occur, organic pathology should be sought at any level of the sexual sphere.
Clinically, primary amenorrhea can be manifested by complete absence of puberty, its underdevelopment, against viral background (enhanced development of masculine traits) or normal female phenotype, which suggests a level of localization of pathology.
Complete absence of puberty is associated with profound underdevelopment of the sexual glands due to chromosomal abnormalities.
The delay in sexual development is most often due to organic damage to brain structures (tumors, trauma, meningitis, encephalitis, intoxication). At the forefront of such women is an increased psychoemotional excitability, about which they often are registered with psychiatrists. Functional disorders of hypothalamic-pituitary regulation are caused by a violation of the production of sex hormones by the hypothalamus or pituitary gland (hypothalamic or pituitary hypogonadism). It is manifested by a delay in puberty on the background of weakly expressed secondary sexual characteristics (sparse hair, underdeveloped mammary glands), reduced body size of the uterus and ovaries, a decreased content of estrogens in the blood and a virtually complete absence of luteinizing and follicle-stimulating hormones.
The absence of menarche against the background of pronounced virilization (increased hairiness, development of the figure according to the male type, coarsening of the voice) is most often associated with a violation of the functional activity of the adrenal cortex, hormone-producing tumors of the ovaries and adrenals formed in the prepubertal period.
Congenital malformations of female genital organs lead to primary amenorrhea, in which the phenotype is typically feminine, since hormonal activity is not impaired. These include aplasia of the uterus and vagina (complete or partial absence of these organs), as well as ginatrezia (fusion along the genital canal). Vaginal atresia can also develop as a consequence of infectious childhood diseases (measles, diphtheria ) or traumatic injuries in the perineum.
Secondary amenorrhea develops in women and girls after a certain period of menstruation. Dysfunction of the hypothalamic-pituitary system, manifested by a violation of the rhythm of the secretion of hormones that regulate the cyclicity of the ovaries, develops due to chronic stress and other causes described in the section on physiological amenorrhea. Organic damage to the hypothalamus or anterior lobe of the pituitary gland, the most common of which is Shihan syndrome (pituitary hemorrhage in the postpartum period), lead to persistent violations of the menstrual-ovarian cycle and require substitution therapy.
Secondary amenorrhea is also observed when ovaries are exposed to ionizing radiation, hormonally active ovarian tumors, polycystic ovary syndrome, premature menopause and a syndrome of pituitary-insensitive ovaries. Damage to the endometrium with a loss of its ability to respond to hormonal stimulation can also be the reason for the absence of menstruation.
Diagnostic measures and basic principles of amenorrhea treatment
Diagnosis of amenorrhea is based on clinical data, complaints of the patient for the absence of monthly for six months or more and the results of a comprehensive laboratory and instrumental examination. A number of tests that determine the hormonal activity of the hypothalamus, the pituitary gland, the functional status of the ovaries and the uterus, and a gynecologist is mandatory. In some cases, an MRI or radiography of the head with the area of the Turkish saddle, where the pituitary gland is located, is prescribed.
After determining the cause of the violation in the female sexual sphere, appropriate treatment is prescribed. The mechanisms of the development of the disease, the level of the lesion of the reproductive system and its hormonal regulation, the woman's environment, the presence or absence of children should be taken into account. Necessary to normalize the diet, adequate rest, walking outdoors, moderate exercise, fortifying procedures, from food supplements - iodinated products, vitamin therapy and immunomodulators. With hypothalamic hypothalamic-pituitary system and ovaries, appropriate hormonal drugs are prescribed to stimulate the ovulatory function of the ovaries. Hyperprolactinaemia, caused by prolonged intake of oral contraceptives, is successfully cured by taking bromocriptine preparations, the dose and duration of treatment depend on the level of prolactin in the blood. Primary amenorrhea is treated with estrogens used in a cyclic mode to normalize the development of the genital organs.