Amenorrhea
An important indicator of female health in reproductive age is the regularity of the ovarian-menstrual cycle. When deviations in one direction or another, legitimate questions arise about violations of the health of the female genital 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 amenorrhea. The female organism is a rather variable system and the influence of various external and internal factors on it during certain life periods can have a significant impact on the activity of the endocrine glands, the course of biochemical reactions, metabolic processes, psycho-emotional sphere and lead to unexpected reactions, including amenorrhea including.
Amenorrhea in a woman who has reached puberty is often a cause for concern. However, is it always justified? In most cases, of course, the absence of menstruation signals a serious illness requiring immediate treatment. But some manifestations of physiological conditions caused by functional changes in the female body under the action of hormones - either their own or coming from outside with medication drugs can lead to amenorrhea.
For reasons of occurrence, there are several types of amenorrhea: false and true. False, as the name implies, does not imply violations of the hormonal cyclicity. Monthly at the same time come according to the schedule, but there is no discharge. The reason is any obstacle in their way along the sexual channel. Most often, this type of amenorrhea occurs when the congenital abnormal development of the vagina and hymen - atresia (adhesions), which is quite simply eliminated surgically. In the absence of disturbances in the hormonal sphere, ovaries and other genitals, the absence of cyclic menstrual bleeding is called true amenorrhea.
Depending on the developmental mechanisms, physiological and pathological amenorrhea is isolated. The processes leading to true physiological amenorrhea are considered completely natural.
With physiological amenorrhea, there are no organic changes in the woman's body, the reasons for her appearance are hormonal. Knowledge of the features of the functioning of the female endocrine system allows you not to worry about the non-occurrence of menstruation in the designated period under the following conditions:
- physiological amenorrhea occurs during pregnancy and for several months after giving birth while breastfeeding. Responsible for this process are the hormones of the ovaries (progesterone) and the pituitary gland (prolactin), which are responsible for the preservation of the fetus, its bearing during the prescribed time, the formation of milk in the mammary glands and the reverse development of the uterus in the postpartum period.
- menopausal women also lack menstruation. This is a physiological phenomenon associated with the age-related extinction of fertility and the gradual termination of the hormonal activity of the ovaries. In the climax, the female reproductive system undergoes a process of reverse development, the logical outcome of which is the occurrence of amenorrhea.
- Childhood before menarche (first menstrual bleeding) is also considered one of the types of physiological amenorrhea.
- stressful situations for the body can also lead to fluctuations in the level of female hormones in the blood and the cessation of 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, which seem to have nothing to do with the functioning of the reproductive system, can in fact have a serious impact on the female body. Their action is carried out all through the same change in the hormonal background and the amenorrhea they cause can be called conditionally physiological.
- modern life, with its unreasonable demands for female beauty, often makes women in the literal sense of the word bully their bodies, leading them to fainting diets and physical training. At best, this is fraught with the termination of menstruation. At worst - severe mental disorders and irreversible changes in the state of the internal organs. Constantly losing weight girls and women should remember that the subcutaneous fatty tissue is a kind of depot for female sex hormones - estrogen, and with a loss of its weight below 22%, menstruation will remain just a memory.
- professional athletes, as well as women engaged in hard physical labor, often suffer from amenorrhea. Constant stress, disproportionate physical exertion, low-calorie diet, non-compliance with the daily regimen, constant travels and flights require the mobilization of all forces. The body understands that such living conditions are incompatible with pregnancy and includes protective mechanisms - the ovarian-menstrual cycle stops. There comes a sports amenorrhea.
- hormonal contraceptives can contribute to the development of amenorrhea, not only during their use, but even some time after discontinuation. This is due to the suppression of the production of the own hormones by the pituitary gestagens contained in contraceptives. In the absence of diseases of the pituitary and ovaries, cyclic bleeding is restored within a few months after discontinuation of the drugs. If this does not happen, you should contact your gynecologist and undergo a detailed examination of the body.
- severe chronic and infectious diseases that lead to the depletion of the body, postoperative conditions, thyroid dysfunction can also cause the cessation of menstruation. In this case, the main disease should be treated, 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 a detailed examination and treatment of comorbidities.
Pathological amenorrhea develops due to various organic or functional disorders, and most often due to their combination, at any level of the female reproductive system. This condition is already not just a temporary violation, but an independent disease and serves as a reason for contacting a specialist. The depth of the violation of reproductive function distinguish primary and secondary amenorrhea.
Types of primary and secondary amenorrhea:
- Hypothalamic.
- Pituitary.
- Adrenal.
- Ovary.
- Uterine.
It is possible to talk about primary amenorrhea if a girl at the corresponding age does not have menarche. There are many reasons for this condition, but it is still quite rare. Most often there is a genetically determined failure of the ovaries and menstruation occurs at a rather late age - after 17 years. Otherwise, if the monthly has not come, you should look for organic pathology at any level of the sexual sphere.
Clinically, primary amenorrhea can manifest itself as a complete lack of puberty, its underdevelopment, against the background of virilization (enhanced development of male traits) or the normal female phenotype, which suggests the level of localization of the pathology.
The complete absence of puberty is associated with a deep underdevelopment of the gonads due to chromosomal abnormalities.
Delayed sexual development is most often caused by an organic lesion of the brain structures (tumors, injuries, meningitis, encephalitis, intoxication). At the forefront of such women is increased psycho-emotional excitability, about which they are often registered with psychiatrists. Functional disorders of the hypothalamic-pituitary regulation are caused by impaired production of sex hormones by the hypothalamus or pituitary (hypothalamic or pituitary hypogonadism). Manifested by delayed puberty against the background of poorly expressed secondary sexual characteristics (poor body hair, underdeveloped mammary glands), reduced size of the body of the uterus and ovaries, reduced levels of estrogen in the blood and the almost complete absence of luteinizing and follicle-stimulating hormones.
The absence of menarche against the background of pronounced virilization (increased hair growth, male-shaped body development, voice coarsening) is most often associated with impaired functional activity of the adrenal cortex, hormone-producing tumors of the ovaries and adrenal glands formed in the prepubertal period.
Congenital malformations of the female genital organs lead to primary amenorrhea, in which the phenotype is typically female, since the hormonal activity is not disturbed. These include aplasia of the uterus and vagina (complete or partial absence of these organs), as well as gynatresia (adhesions along the sexual canal). Atresia of the vagina can develop as a result of past infectious children's diseases (measles, diphtheria ) or traumatic injuries in the perineal area.
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 secretion of hormones that regulate the cyclical nature of the ovaries, develops due to chronic stress and other causes described in the section on physiological amenorrhea. Organic lesions of the hypothalamus or the anterior lobe of the pituitary gland, the most among which is Sheehan's syndrome (hemorrhage in the pituitary in the postpartum period), lead to persistent violations of the menstrual-ovarian cycle and require replacement therapy.
Secondary amenorrhea is also observed when ionizing radiation acts on the ovaries, hormonally active ovarian tumors, polycystic ovary syndrome, premature menopause, and ovarian pituitary hormone-susceptible syndrome. Damage to the endometrium with the loss of its ability to respond to hormonal stimulation can also be the cause of the absence of menstruation.
Diagnostic measures and basic treatment of amenorrhea
Diagnosis of amenorrhea is based on clinical data, patient complaints about the absence of menstruation 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, pituitary, functional state of the ovaries and uterus are carried out; examination by a gynecologist is obligatory. In some cases, 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 genital area, appropriate treatment is prescribed. The mechanisms of development of the disease, the level of damage to the reproductive system and its hormonal regulation, the environment of the woman, and the presence or absence of children should be taken into account. Normalization of diet, proper rest, walks in the fresh air, moderate exercise, restorative procedures, iodized food supplements, vitamin therapy and immunomodulators are necessary. For hypothalamic-pituitary system and ovarian hypofunction, appropriate hormonal preparations are prescribed to stimulate the ovulatory function of the ovaries. Hyperprolactinemia, due to the long-term use of oral contraceptives, is successfully cured by taking bromocriptine, the dose and duration of treatment depend on the level of prolactin in the blood. Primary amenorrhea is treated with estrogens, which are used cyclically to normalize the development of the genital organs.