Amenorrhea

Amenorrhea is the absence of menstruation. Distinguish between physiological amenorrhea (before puberty, during pregnancy, during lactation, in the period of menopause) and pathological. The latter can be primary, that is, menstruation did not have, and secondary - menstruation were, but then stopped. There are the following main causes pathological amenorrhea.
1. Changing the lining of the uterus after abortion (if the scraping was removed basal, germ, a layer of the endometrium), heavy endometritis, and also in connection with sexual infantilism. In this form amenorrhea function of the ovaries and other endocrine glands may not be violated. 2. The defeat of the ovaries due to inflammation of the uterine appendages, and also in connection with disorders of the endocrine glands (thyroid, adrenal, pituitary , and so on) or pituitary-hypothalamic region. Dysfunction of the pituitary-hypothalamic systems can be caused by the action of neuro-psychic factors (fear, mental injury, fatigue, mental illness), entails a change in the function of the endocrine system and the development of amenorrhea. 3. Infectious diseases acute (fever, scarlet fever) and chronic (TB) can cause temporary amenorrhea. Blood disease (severe anemia, leukemia), cardiovascular system with sharply expressed heart failure also accompanied amenorei. 4. The action of ionizing radiation can cause amenorrhea.
Diagnosis amenorrhea put in if absent menstruation in women of childbearing age. Duration there are 3 degrees amenorrhea: easy - to 1 year, medium - from 1 year to 3 years, heavy - over 3 years. To determine the cause of amenorrhea, and therefore the method of treatment requires special examination woman gynecologist-endocrinologist.
The prognosis depends on the cause and duration of the disease. If amenorrhea associated with profound changes in the nervous and endocrine systems, violated the cyclic changes in the ovary, endometrium, to restore menstruation is very difficult or even impossible.
Treatment depends on the cause of amenorrhea. To start hormone therapy without a gynecologist-endocrinologist is unacceptable. Incorrectly applied hormone treatment can significantly degrade the status of women and to increase the degree of endocrine disorders. Along with pathogenetic treatment restorative therapy with curative physical culture, vitamin therapy, physiotherapy, balneology procedures.

Amenorrhea (from the Greek. negative prefix a-, men - month and rhoia - during, after) is the absence of menstruation. As a physiological phenomenon is observed before the onset of puberty, during menopause, during pregnancy and in some women during breast feeding. It is necessary to distinguish true amenorrhea from the false, or CryptoMemory, which due to mechanical barriers to the outflow (atresia of the vagina or cervix, no holes in the hymen) menstrual blood accumulates in the vagina or uterus and external bleeding does not occur. True amenorrhea can be primary, if a woman has never been menstruation, and secondary, if menstruation were, but then stopped.
Causes of amenorrhea can be divided into local and General. Local causes of amenorrhea can be: congenital absence of the vagina and uterus; the absence of the uterus after her supracervical amputation or after removing; castration surgery or radiation (x-ray, radium); ovarian neoplasms; irreversible destructive processes in the uterus. However, more often the cause of amenorrhea are not so many anomalies sexual apparatus as General disorders extragenital nature. A. often occurs after severe acute infectious diseases (and abdominal typhus fever, paratyphoid, cholera, pneumonia, sepsis), and chronic infectious diseases (malaria, severe articular rheumatism, chronostasis), chronic pulmonary, kidney, ovary; significant anemia. In this case, amenorrhea occurs not only due to the decrease of reactivity of the organism, but also in connection with the deterioration of the power of the ovaries and weakening their hormonal activity. A. sometimes chronic severe diseases of kidney, liver, cardiovascular system; diseases of endocrine glands (diabetes, adipose-genital dystrophy); with mental illness (schizophrenia, psychasthenia, epilepsy); after neuro-trauma, chronic lead poisoning, phosphorus and other; after prolonged exposure to rays x-Ray, radium.
The cause of amenorrhea can be endocrine disorders that are associated with primary ovarian disorders, pituitary or thyroid cancer. At primary defeat of ovarian function of their reduced; in some patients, there has been a continued gradual fading ovarian activity that reminds change their hormonal function in women in the phase of menopause or menopause. In women with decreased function of the ovaries menopause occurs much earlier than women with normal function. Due to insufficient education of estrogen uterus is poorly developed. Along with decreased function of the endometrium there is a small amount of estrogen and increased formation of gonadotropic hormones that occurs in women during menopause. However, menopausal and menopausal syndromes (tides of blood to the head, sweating, dizziness, and others) in women with primary defeat of the ovaries, at a young age are not available. At insufficiency of ovarian function is celebrated also infertility.
Often amenorrhea motivated primary function disorders of the pituitary gland. Such patients often observed obesity due to violations not only the function of the pituitary and hypothalamus. There are cases of pituitary-hypothalamic amenorrhea without obesity, and, on the contrary, there are women with pronounced symptoms of pituitary, but amenorrhea is not suffering. A. on the soil of primary disorders of thyroid function can also occur with Hyper, and when hypothyroidism, as it occurs as a result of direct influence of thyroid hormone in the ovary and indirectly - through the pituitary gland. More often A. meets with hypothyroidism. Basal metabolic rate can be low, and normal.
In those cases, when the balance of sex hormones are not violated, but the reception of the endometrium is greatly reduced, there is the so-called uterine form of amenorrhea. Such A. common in women with advanced inflammatory diseases of genitals, especially when basal endometritis, genital TB, often after intrauterine injection of iodine.


Methods of examination. In amenorrhea in women who lived sex life, produce internal combined gynecological examination female rectal. Define the size of the uterus (sounding cavity), the tumors uterus, ovaries, inflammatory processes, etc. it is Necessary to define the basic currency (the function of the thyroid gland), the study of blood (anaemia), the amount of sugar in the blood and in the urine (diabetes), x-ray region of the Turkish saddle (possible pituitary tumor or other changes), a study of Cytology vaginal smears, and in some cases and histological examination of scraping mucous membrane of the uterus.
Treatment. The nature of therapeutic measures depends on the root cause of amenorrhea (anemia, decreased supply, diabetes, disease of the thyroid gland, hypophysis). Good results are activities aimed at improving blood circulation in the small pelvis.
Primary amenorrhea on the ground of hypofunction of the ovary enter estrogenic hormones within 6-8 weeks. In connection with this dilate blood vessels of the small pelvis, feeding uterus and ovaries, as well as increase the function of the ovaries due to direct exposure to estrogenic hormones. The course of estrogenotherapy is a kind of preparation for further cyclical use of oestrogen hormones in combination with progesterone, gonadotropic hormone and others In secondary amenorrhea find out the type of menstruation until A. and prescribe individual hormonal therapy taking into account usual for this woman's hormonal rhythms. In the basis of such therapy on the principle of artificial introduction of hormonal drugs in the same sequence in which they select with natural, normal menstrual cycle.
To introduce appropriate hormones on certain days, there are the following three phases of the cycle: follicular - from the beginning of menstruation to 12-14 days; ovulatory - 12-14-15th - 17th day and phase yellow body - progesterone - from the 16th to the 18th to 20-28 days. Patients with amenorrhea with 28-day menstrual cycle intramuscularly: 6, 8, 10, 12 days of the cycle - 10 000 IU (1 mg) estrogenic hormones; on 14, 16, 18 th days - 1 mg hormones oestrogen in combination with 5 mg of progesterone (in one sprite); from 20 to 26-th day - to 10 mg of progesterone daily. Patients with amenorrhea with 21-day menstrual cycle hormones injected in the following order: 5, 7, 9th days and 1 mg estrogenic hormones; on the 11th and 13th days and 1 mg hormones oestrogen in combination with 5 mg of progesterone and 15 to 19-th day - to 10 mg of progesterone daily. Counting days lead from the first day of menstruation. Receiving hormones in strictly defined for this patient days, since this therapy is designed not only for the replacement of missing in the body of hormones, but mostly to play the usual rhythmic reactions of the Central and peripheral nature, which were characteristic of this sick certain days of the menstrual cycle.
Extinct reflexes can be quickened and secured with long-term (within 5-6 menstrual cycles) treatment. Upon the occurrence of menstruation to consolidate the results of treatment incremental light therapy, built on the same principle, with the introduction of polovinnah doses of hormones. At insufficiency in the anterior pituitary good effect is the introduction of gonadotropic hormones, especially among women with secondary amenorrhea. Gonadotropic hormones injected intramuscularly in a dose of 600 IU (500 - follicle-stimulating and 100 - gonadotropin-releasing the luteinizing hormone) within 2-3 days before the supposed" ovulation (9-14-day cycle). In all cases hormonal therapy should be combined with the introduction of vitamins, mainly a, C, B1, E. Cm. also the Menstrual cycle.