Symptoms of amenorrhea and methods of treating the pathological condition

What is amenorrhea? This is a term used to refer to a condition characterized by the absence of menstruation.

With amenorrhea, wave-like cyclic changes are absent or insufficiently expressed in a woman’s body, the physiological end of which is menstruation (if pregnancy does not occur).

Classification of amenorrhea

In gynecology, the following classifications of amenorrhea are used.

True and false

It is primarily divided into:

True amenorrhea

It is characterized by the absence in the body of any changes characteristic of the menstrual cycle, or they are not expressed enough (no menstruation).

False amenorrhea

This type is observed in women against the background of a normal menstrual cycle, which is accompanied by the absence of menstruation. The causes of this pathological condition are:

• solid hymen,
• cicatricial narrowing of the vagina resulting from inflammatory diseases of the vagina and uterus.

Physiological and pathological

In addition to true and false, gynecologists classify amenorrhea into the following types:

• physiological,
• pathological.

Physiological amenorrhea

It is typical for girls, pregnant and breastfeeding women and the elderly.

Pathological amenorrhea

It occurs against the background of a wide variety of morphological and functional changes in the body, as well as due to the harmful effects of environmental factors.

Pathogenetic classification

There is also a pathogenetic classification of amenorrhea.

Depending on the disruption of the activity of one or more links in the biological chain “central nervous system - pituitary gland - ovary - uterus”, it is customary to distinguish four forms of amenorrhea:

1. Amenorrhea of ​​central origin.
2. Hypothalamic-pituitary amenorrhea.
3. Ovarian amenorrhea.
4. Uterine amenorrhea.

Amenorrhea of ​​central origin

During the war years, evidence of the occurrence of psychogenic amenorrhea was observed in connection with strong negative emotions (fear, stress, grief, etc.).

Hypothalamic-pituitary amenorrhea

It occurs in various diseases of the hypothalamic-pituitary system. Depending on the degree of pituitary insufficiency, varying degrees of anatomical underdevelopment and functional insufficiency of the ovaries are observed, and consequently, varying degrees of changes in the myometrium and endometrium. Damage to the pituitary gland may be accompanied by primary or secondary amenorrhea.

Ovarian amenorrhea

This form is observed with insufficient ovarian function or its complete absence.

The body of such women has few follicular hormones and at the onset of the disease the amount of gonadotropic hormones is increased.

If the follicle matures, but the corpus luteum does not form and there is no ovulation, then polyhormonal (folliculinogenic) amenorrhea occurs, which is replaced by heavy bleeding.

Uterine amenorrhea

It occurs with a wide variety of pathologies in the uterus.

Causes of amenorrhea

The causes of amenorrhea can be:

• deep nervous shocks,
• mental fatigue
• severe infectious diseases,
• nutritional dystrophies;
• diseases of the body with localization of the pathological focus in the female reproductive system, namely:
  • with suppurative processes in the ovaries,
  • for tuberculosis and tumors of the uterine appendages;
• endometrial trauma:
  • with rough curettage (when not only the functional but also the basal layer is removed),
  • when cauterizing the uterine mucosa with iodine and other cauterizing substances.

It is also worth saying that the cause of amenorrhea can be exposure to significant doses of X-rays and radium, as well as after surgical interventions involving removal of the uterus or ovaries.

Pathogenesis of amenorrhea

The mechanism of development of amenorrhea depends on the causes that cause it and the properties of the given organism. However, many authors believe that no matter how diverse the influencing factors are, they all affect the central nervous system, which is the regulator of all body functions.

If amenorrhea is observed for a long time, then a trophic disorder gradually occurs in the ovaries, and then in other parts of the reproductive apparatus: the ovaries decrease in size, the processes of follicle maturation, ovulation and the development of the corpus luteum gradually cease. Atrophic processes in the muscular and mucous layers occur in the uterus earlier than in the vagina and external genitalia. It is believed that the same mechanism for the development of amenorrhea occurs in general diseases of the body and chronic intoxication.

Some authors have found that toxins destroy the follicular apparatus of the ovaries. In diseases of the pituitary gland, amenorrhea occurs because the production of pituitary gonadotropic hormones, which stimulate the activity of the ovaries, decreases or stops.

Symptoms of amenorrhea

The clinical picture of all forms of amenorrhea has many common symptoms.

Symptoms of primary amenorrhea

Patients suffering from primary amenorrhea usually experience:

• little uterus,
• conical cervix,
• vagina is narrow,
• the vaginal vaults are flattened,
• scanty development of hair on the pubis, in the armpits,
• development of mammary glands is slowed down.

Symptoms of secondary amenorrhea

With short-term secondary amenorrhea, changes in the reproductive apparatus may be absent. With a long course of the disease, changes occur in the reproductive system associated with trophic disturbances. These include:

• decreased secretion of glands,
• atrophy of the mucous membranes and muscular elements of the genital organs,
• changes in the tone of the uterus and ligamentous apparatus,
• reduction in the size of the ovaries, etc.

With secondary amenorrhea, the following may appear:

• headache,
• irritability,
• fast fatiguability,
• sensation of sudden heat in the face (“hot flashes”),
• sweating is often observed,
• increased blood pressure,
• change in heart rate.

In the uterine form of amenorrhea, these phenomena are absent.

Pituitary amenorrhea is usually accompanied by metabolic disorders - weight loss or obesity (with the greatest accumulation of fatty tissue observed mainly on the hips and pelvic area), sometimes with symptoms of acromegaly.

Diagnosis of amenorrhea

Diagnosis of amenorrhea is carried out on the basis of clinical and laboratory studies. It is necessary first of all to find out the circumstances under which menstruation stopped. In case of primary amenorrhea, the sella turcica is examined radiographically in order to exclude diseases of the pituitary gland, and the genital organs (vagina, uterus, appendages, etc.) are examined.

When diagnosing amenorrhea, the so-called “pupil phenomenon” is used.

During normal ovarian activity, during the period of follicle maturation, the glands of the cervical mucosa produce copious amounts of mucus, and on the 8-9th day of the cycle, the external opening of the cervix expands and is filled with transparent glassy mucus.

Under artificial light, the external pharynx appears dark, resembling a pupil. With amenorrhea due to insufficiency or absence of follicular hormone, there is no “pupil symptom”.

To determine the nature of amenorrhea, the content of sex hormones in the urine is determined. Depending on the type of amenorrhea and its severity, the content of hormones in the urine varies. With the so-called psychogenic amenorrhea, the content of both folliculin and gonadotropic hormones decreases.

With ovarian amenorrhea, there is a decrease in the amount of follicular hormones (estrogens) and an increase in the content of gonadotropic hormones.

To clarify the diagnosis, sometimes they resort to examining a scraping of the uterine mucosa. Most often, with amenorrhea, atrophic mucous membrane of the uterine body is noted.

Treatment of amenorrhea

Treatment of amenorrhea should be strictly individualized and aimed at eliminating the cause of the disease.

Amenorrhea that occurs after infectious diseases usually does not require hormonal treatment. Menstruation usually returns a few months after recovery. Amenorrhea caused by chronic diseases requires elimination of this disease. If amenorrhea is caused by intoxication, the latter must be eliminated.

Complex treatment

With prolonged primary amenorrhea, comprehensive treatment should be carried out, which consists of general hygiene measures, hormone therapy, the use of restoratives, vitamins and various thermal procedures. Complex treatment strengthens the body, normalizes the regulation of the functions of the reproductive apparatus, and restores the impaired activity of the endocrine glands.

General restorative treatment

Iron and aloe preparations are used as general strengthening agents.

It is believed that aloe causes hyperemia of the pelvic organs.

Hormone therapy

Hormones introduced into a woman’s body have either a replacement effect (replace missing hormones) or a stimulating effect. The principle of hormonal therapy is to respond to physiological hormonal relationships in the body, so hormones are usually used depending on the form and degree of amenorrhea.

For ovarian amenorrhea, combined hormonal treatment is carried out, first with folliculin, and then with a hormone produced by the corpus luteum.

Progesterone causes a secretory reaction of the endometrium, reduces the sensitivity of the uterus to substances that cause its contraction, helps create conditions for the fertilization of the egg and the maintenance of the resulting pregnancy, and stimulates the development of the alveoli of the mammary gland.

Estrogenic substances are used in the form of natural follicular hormones (estradiol and estrone) or in the form of synthetic drugs (diethylstilbestrol and sinestrol). The corpus luteum hormone is used in the form of progesterone.

In primary amenorrhea, estrogens are administered intramuscularly to stimulate the growth of the genital organs. If menstruation does not appear, the course of treatment is repeated.

For secondary amenorrhea in women over 40 years of age with slight hypotrophy of the genital organs, estrogens are used, but in smaller doses, and then progesterone in the same doses.

Vitamin therapy

Along with hormones, vitamins B1 and C are also used in the treatment of amenorrhea. Vitamin B1, according to some authors, regulates the function of the gonads.

Physiotherapeutic treatment

In addition to general strengthening therapy and hormonal treatment, climatic effects are also used, as well as various thermal procedures:

• hot mud baths with temperatures up to 45-50°C,
• applications,
• diathermy 20-30 sessions lasting 30 minutes at a current of 1.5-2 A.

Thermal procedures act reflexively, causing hyperemia of the pelvic organs.

Prognosis for amenorrhea

The prognosis for amenorrhea depends on the causes and duration of the cycle disorder. In women with primary amenorrhea with a large degree of underdevelopment of the genital organs, treatment may not give positive results. Psychogenic forms of amenorrhea that exist for a short time are easily treatable. When treated with sex hormones, the functions of the nervous system, pituitary gland and ovaries are normalized. In cases of prolonged secondary amenorrhea, long-term hormonal treatment is required.

Source: http://NewVrach.ru/amenoreya.html

Amenorrhea - causes and modern methods of treatment

• What is amenorrhea
• Amenorrhea is a disorder of the menstrual cycle, manifested by the complete absence of menstruation in women of childbearing age for six months or more.
• The absence of menstruation, not associated with pregnancy or lactation, is a symptom that indicates the presence of a serious gynecological pathology.
• The pathological condition can be caused by disturbances at the levels:

• anatomical;
• biochemical;
• genetic;
• physiological;
• mental.

The secondary form of amenorrhea occurs in up to 3% of cases.

Make an appointment with a gynecologist

Specialists of the Center for Gynecology, Reproductive and Aesthetic Medicine provide highly qualified medical care in the treatment of gynecological diseases.

Remember:

Self-medication can aggravate the situation and lead to irreversible consequences!

Violation of the reproductive function of the female body is often associated with amenorrhea.

Depending on the level of damage, 6 main types of pathological conditions may develop:

01. Central shape.

Occurs due to brain damage.

02. Hypothalamic form.

Characterized by damage to the hypothalamus:

• against the background of sudden weight loss;
• psychogenic in nature.

03. Pituitary form.

Occurs due to damage to the pituitary gland:

• hyperprolactinemia;
• hypogonadotropic amenorrhea.

04. Ovarian form.

Occurs due to ovarian pathologies:

• ovarian wasting syndrome. Characterized by the decline of ovarian function up to 38 years of age;
• resistant ovarian syndrome. Characterized by a lack of ovarian response to the pituitary gland;
• virilizing tumors of the ovaries.
• PCOS, or polycystic ovary syndrome. With this pathology, the ovaries are covered with a dense membrane that cannot rupture on its own during ovulation. The synthesis of sex hormones is disrupted: the production of estrogens is reduced, and androgens are increased.

05. Uterine form.

Develops due to pathology of the uterus with intrauterine synechiae, or Asherman's syndrome;

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Causes of primary amenorrhea

The causes of amenorrhea depend on its type.

Among the causes of the primary form of pathology are:

• developmental anomalies of the female reproductive organs;
• delayed sexual development;
• heredity;
• disorders of intrauterine development of the fetus;
• physiological reasons associated with incomplete puberty.

If delayed menarche is observed, the development of secondary sexual characteristics and the condition of the hymen should be assessed.

Among the causes of the primary form of pathology are:

• developmental anomalies of the female reproductive organs;
• delayed sexual development;
• heredity;
• disorders of intrauterine development of the fetus;
• physiological reasons associated with incomplete puberty.

Timely treatment starts leaving favorable chances for the woman. Much depends on the type of amenorrhea, so you should not wait for six months or more to miss your period, but contact a specialist in a timely manner.

Only careful attitude to your health and the help of a specialist will help you avoid many consequences.

Make an appointment with a gynecologist

The main symptom of amenorrhea is the absence of menstruation for 6 months or more. This symptom is present in any form of pathology. Other additional signs make it possible to clarify the form of amenorrhea and prescribe adequate therapy for the cause of the disease.

• pain in the lower abdomen of a cramping, pulling or aching nature due to the accumulation of menstrual blood;
• headache;
• nausea;
• engorgement of the mammary glands, accompanied by pain.

• leakage of milk from the mammary glands;
• headache;
• psychosomatic disorders.

• heartache;
• feeling of a rush of heat;
• increased weakness and fatigue.

Diagnosis of amenorrhea includes:

• Patient's complaints.
• Collection of anamnesis of the disease, heredity and gynecological status.
• General somatic examination with determination of secondary sexual characteristics, type of hair growth, discharge from the mammary glands.
• Gynecological examination.
• Laboratory examination.
• Special examination methods.

Our center provides all the necessary methods for diagnosing endometriosis:

• The test is considered negative if there is no menstrual-like bleeding upon drug withdrawal. This indicates the absence of estrogen influence on the endometrium.
• A test with the appearance of bloody discharge from the genital tract for drug withdrawal is considered positive.

Special examination methods make it possible to determine the cause of amenorrhea and prescribe adequate therapy. Research methods include:

1. Study of genetic material to exclude genetically determined pathology.
2. X-ray examination of the skull. Allows you to exclude tumor-like formations of the pituitary gland and hypothalamus.
3. MRI, CT. Necessary to exclude brain damage.
4. Ultrasound of the pelvic organs to exclude pregnancy or abnormal development of the internal genital organs.
5. Ultrasound of the thyroid gland.
6. Ultrasound of the adrenal glands.
7. Endoscopic examination:
   • hysteroscopy. An instrumental examination of the uterine cavity is performed;
   • hysterosalpingography;
   • laparoscopy. The abdominal cavity is examined.
8. ultrasonic scanning method
9. spiral computed tomography or MRI method
10. Hysteroscopy and Minihysteroscopy (office hysteroscopy)
11. Consultation of related specialists:
    • endocrinologist;
    • neurologist;
    • psychiatrist.

Treatment of amenorrhea

Treatment of amenorrhea depends on its type and severity. Therapy is aimed at eliminating the cause of the pathology.

Treatment for amenorrhea can be:

• Operational.
• Conservative.

Surgical interventions are necessary in cases of primary amenorrhea caused by abnormalities in the development of the girl’s genital organs. In this case, reconstructive surgery is performed to allow menstrual blood to exit the uterine cavity.

In case of secondary amenorrhea caused by endometrial pathology, hysterography or hysterosalpingography is indicated.

Laparoscopic intervention is indicated if a woman has polycystic ovaries. The operation allows you to remove the dense membrane on the ovary and provoke ovulation.

Conservative treatment consists of prescribing hormonal therapy, which depends on the type of amenorrhea.

The main hormonal drugs used are:

1. Estrogens. Necessary for normalizing menstrual function.
2. Gestagens.
3. Analogs of gonadotropin-releasing hormones. Prescribed for pathologies of the pituitary-hypothalamic system.
4. Combined oral contraceptives, or COCs. Necessary for contraception and regulation of the menstrual cycle.
5. Thyroid hormones. Used for her diseases.

The duration of hormone replacement therapy depends on the type of amenorrhea and its severity. They can be prescribed in courses or before the onset of menopause.

The most dangerous complication of any type of amenorrhea is infertility.

Infertility

The absence of menstruation does not allow the egg to mature.

A woman avoids intimacy, she develops depression, a feeling of helplessness, irritability, and hormonal disorders. Due to uterine dysfunction, relationships between partners become strained.

1. Accompanying illnesses
2. Another complication of amenorrhea can be extragenital diseases associated with a lack of estrogen, such as osteoporosis, diabetes, and heart disease.
3. Cancer
4. Lack of estrogen increases the risk of endometrial malignancy or the development of hyperplastic reactions in the uterus.

Maintaining a healthy lifestyle, which means:

• balanced diet;
• weight control;
• avoidance of stressful situations;

Visit an obstetrician-gynecologist at least once a year if there are no complaints and more often if they exist.

Source: https://drugayaginekologiya.ru/lechenie/amenoreya/

Amenorrhea - symptoms, treatment, causes of the disease, first signs

Diet for amenorrhea is of great importance. However, it should directly depend on the causes of the disease. So, if the cause of amenorrhea in a patient is fasting, then a high-calorie diet is indicated for her, and if the pathology is caused by Itsenko-Cushing's disease, the amount of food consumed, on the contrary, should be reduced.

• However, no matter what the diet, nutrition during amenorrhea should always be complete, that is, a woman should not consume vitamins, fats, proteins, carbohydrates in quantities less than the daily norm.
• With amenorrhea, it is very important to normalize the patient’s weight, since menstruation cannot proceed normally both with excess weight and with underweight.
• To restore the functioning of the reproductive organs, it is also necessary to stop drinking alcohol and cigarettes, and normalize work and rest patterns.
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Treatment with drugs

Primary amenorrhea is most often treated with hormonal pills and a special diet that promotes weight gain through muscle mass. Vitamins for amenorrhea in the primary form are a mandatory form of treatment.

In addition to special vitamin complexes for amenorrhea (vitamin E, vitamin B1 in solution, folic acid), it is recommended to introduce into the diet foods containing vitamin E, estrogen, folic acid, vitamins that provide significant assistance for amenorrhea.

Estrogen is found in:

• legumes;
• bran;
• apricots;
• coffee.

The following foods contain folic acid:

• spinach;
• salad;
• dark greens;
• celery;
• berries;
• peas;
• carrot;
• pumpkin;
• corn.

Vitamin E for amenorrhea is replenished by:

• sea ​​fish;
• greenery;
• berries;
• porridge;
• nuts.

Taking vitamins during amenorrhea strengthens the nervous system and creates the prerequisites for restoring reproductive function naturally.

Treatment of amenorrhea with vitamin preparations reduces nervous tension and improves tone. If this is the primary form, then pills for amenorrhea may not be needed, the function of the ovaries will recover on its own.

Drugs for amenorrhea for girls are prescribed only in severe cases.

Vitamins, hormones, drugs (Folliculin, Cyclovita) and physical exercise eliminate health problems in teenage girls. Vitamin complex Cyclovita is a drug that replenishes the lack of minerals and vitamins and restores the tone of a weakened body.

1. Treatment with hormonal drugs is prescribed when a special diet and vitamin complexes do not help.
2. Primary amenorrhea caused by infectious diseases or intrauterine infections is treated with special medications.
3. In case of secondary type amenorrhea, in addition to hormones, they are treated with special diets, physiotherapy and vitamins necessary for patients of any age.

For secondary amenorrhea, specialists may prescribe the hormonal drug Duphaston. This is a progestogenic hormonal drug that includes dihydrogesterone. Duphaston is used for primary and secondary amenorrhea as hormone replacement therapy. Treatment of amenorrhea with Duphaston allows for effective therapy for patients of reproductive age.

Treatment of amenorrhea with Duphaston can be replaced with its analogue Utrozhestan. The drug is natural progesterone. Utrozhestan compensates for the deficiency of endogenous progesterone and replaces several drugs prescribed for the treatment of amenorrhea. Utrozhestan has no side effects and is quickly eliminated from the body.

Also, patients with amenorrhea are prescribed hormonal drugs to restore ovarian function in tablets.

Treatment of amenorrhea with replacement therapy drugs:

• Progestin drugs: Utrozhestan, Duphaston, Pregnin, Norkolut. For amenorrhea, these drugs are widely used to treat primary and secondary forms.
• Estrogens: Femoston, Femoston 210, Rigevidon.
• GnRH hormones: Cyclomate. Used to treat amenorrhea caused by polycystic ovary syndrome.
• Non-steroidal synthetic drugs: Clomiphene. These tablets stimulate ovarian function.

Cyclodinone (an analogue of Utrozhestan) is prescribed for amenorrhea to restore the cycle and prevent early menopause. Cyclodinone contains twig berry extract.

For amenorrhea, Femoston, like Cyclodinone, is used in case of insufficient hormone production.

Femoston helps restore the cycle against the background of stressful situations and sudden weight loss. It is prescribed to women after 40 years of age to delay early menopause, which is based on a deficiency of female sex hormones associated with women reaching a certain age. Femaston helps prevent hot flashes, emotional breakdowns, bone depletion, headaches, and dry mucous membranes.  

Femoston lowers blood cholesterol levels, lowers LDL and increases HDL, prevents the risk of carcinogenesis and endometrial diseases.

Folk remedies

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Treating amenorrhea with folk remedies is a common practice, but this approach is safe only in consultation with a doctor. This is necessary due to possible individual intolerance to medications.

Herbs for primary amenorrhea

It is impossible to induce menstruation with such a deviation using homeopathy, but improving hormonal levels and general well-being is a solvable task. Applicable:

• infusion of oregano. Has a calming effect;
• sage extract is a phytohormone with properties similar to female sex hormones.

Folk remedies in the case of primary amenorrhea usually provide only maintenance therapy; this form of the disease requires a more radical approach.

Folk remedies for secondary amenorrhea

Herbal treatment for this disease has a certain therapeutic effect. In order not to cause harm to the body, it is necessary to find out the cause of amenorrhea and consult a gynecologist.

The most common and effective means:

• hog uterus. Used in the form of an alcohol tincture or an aqueous solution, it is especially effective for hormonal disorders;
• taking a warm bath before bed with a decoction of mantle root;
• Oregano in the absence of menstruation is a means of restoring hormonal levels. The plant contains estrogens similar to those of women; an infusion of boiling water is used;
• According to many patients, elecampane promotes the rapid onset of menstruation during amenorrhea. The greatest results can be achieved with a delay of up to 10 days. They use the root of the plant, it is worth remembering that this is a very strong remedy, the dosage of the medicine must not be exceeded;
• olive oil mixed with viburnum berries;
• an infusion of onion peels (also according to reviews) relieves not only gynecological ailments, but also strengthens the body;
• to speed up the onset of critical days, grated citrus fruits are used - lemon or orange mixed with sugar;
• Parsley is one of the fastest-acting remedies, especially the juice of the plant. Both parsley stems and seeds are used. Finely chopped herbs are brewed in a thermos for about 12 hours. The seeds must be poured with warm boiled water and drunk in small sips;
• Hormel is a homeopathic medicine, it contains several plants that have a positive effect on the reproductive system during amenorrhea. Common columbine in the composition of the product is effective in the absence of menstruation, also has a calming effect and helps with sleep disorders;
• taking a bath with cocoa will not only speed up the onset of menstrual periods, but will calm and improve your mood;
• red brush shows the greatest activity when collected with hogweed and sage. When treating amenorrhea, such an infusion normalizes the functioning of the humoral and endocrine systems.

Under no circumstances should these medications be used if pregnancy is suspected; this can lead to serious complications and even death. In the absence of menstruation, be sure to do a rapid test and visit a doctor, and only then begin treatment for amenorrhea with folk remedies.

The information is for reference only and is not a guide to action. Do not self-medicate. At the first symptoms of the disease, consult a doctor.

Source: https://yellmed.ru/bolezni/amenoreya

Psychogenic amenorrhea

1. Psychogenic amenorrhea
2. Treatment

Psychogenic amenorrhea is called “prison amenorrhea” because the cause of this disease is mental disorders.

They can be short-term or long-term. Amenorrhea is the cessation of menstruation in women for 180 days or more. Psychogenic (nervous) amenorrhea occurs from stress.

An example of psychogenic amenorrhea is “wartime amenorrhea.” Wartime amenorrhea has a complex genesis: it is excessive mental shock, anxiety for the life and health of loved ones and relatives, for the fate of the Motherland. With military amenorrhea, the menstrual cycle is usually restored after the elimination of excessive mental shocks.

Main symptoms of psychogenic amenorrhea

In addition to the absence of menstruation for 180 days or more, the clinical symptoms are psychopathological and psychopathic dysfunctions, which are expressed in the form of astheno-depressive syndrome.

In women of reproductive age, there is a decrease in the reserve capacity of the pituitary-hypothalamus-ovarian system, estrogen levels and an increase in the hormone cortisol. Based on this, women completely lack ovulation, so there is no chance of conceiving a child.

According to the results of a clinical blood test, no deviations from the norm are observed; sometimes the hemoglobin level may be reduced due to exhaustion of the body. Negative factors affecting the cerebral cortex lead to psychogenic amenorrhea.

Such factors are severe psychological trauma (death of loved ones, severe fear, being under constant stress, problems in personal life), which is why this disease is called “prison” amenorrhea.

During a psychogenic effect, the cerebral cortex takes the entire “blow”, thereby trying to reduce the negative impact on other organs by secreting substances (opiates) from brain structures that reduce discomfort during nervous tension.

Thanks to opiates, the secretion of the neurotransmitter dopamine is significantly reduced, due to which nerve impulses enter the brain cells much more slowly, reducing the negative impact on the human body.

Therefore, when the level of hormones of the pituitary-hypothalamus system is disrupted under the influence of psychogenic factors, disturbances in the functioning of the ovaries occur.

Thus, the level of female sex hormones (estrogen and progesterone) decreases, which contributes to the suppression of ovulation and the development of the endometrium, as a result of which its mucous membrane is not rejected and monthly menstruation does not occur for a long period (6-12 months).

The course of psychogenic amenorrhea

Nervous amenorrhea is characterized by a sudden cessation of monthly bleeding in a woman, accompanied by neuropsychiatric disorders. Signs of this disease may include:

1. depression;
2. general weakness;
3. trembling of limbs.
4. increased fatigue;
5. suicidal tendencies;
6. neurosis;
7. obsessive state (anxiety and suspiciousness);
8. tearfulness;
9. hypochondriacal syndrome (suspecting yourself or your loved ones of serious illnesses that are not confirmed by the results of clinical studies).

All symptoms can be either temporary or permanent. Sometimes they disappear on their own, without relapses, but without medical help, improvements may not occur for a long time.

Diagnosis and treatment of psychogenic amenorrhea

A gynecologist-endocrinologist can diagnose psychogenic amenorrhea. Often a woman needs the help of a psychologist.

Diagnosis of this disease involves testing for thyroid hormones and sex hormones, magnetic resonance imaging of the brain, a gynecological examination of a woman in a chair, an ultrasound examination of the pelvic organs, a general blood and urine test, and mammography. If necessary, laparoscopy is performed to examine the uterine cavity, ovaries and appendages.

Treatment of psychogenic amenorrhea is prescribed by a doctor based on the results of a medical examination.

In most cases, a woman is prescribed hormone replacement therapy (in particular, synthetic progesterone, which is contained in the drugs Duphaston, Utrozhestan), vitamins, and in case of an advanced form of the disease, tranquilizers (prescribed by a neurologist or psychiatrist). It is worth knowing that without a doctor’s prescription, self-administration of any medications poses a health risk, so consultation with a specialist is required.

Treatment of psychogenic amenorrhea is facilitated by proper nutrition, proper rest, walks in the fresh air, taking vitamins and positive emotions.

Treatment

Let’s try to figure out what psychogenic amenorrhea is and the treatment of psychogenic amenorrhea.

This concept includes the absence of menstruation against the background of mental and emotional disorders, when exposed to psychological trauma during the reproductive period.

Its occurrence is due to the fact that amenorrhea under stress is caused by changes in the production of hormones and mediators that affect the production of gonadotropins.

Source: https://amenorhea-and-infertility.ru/psixogennaya-amenoreya-diagnostika-lechenie.html

Pathological amenorrhea

Pathological amenorrhea is caused by many factors. Absolute amenorrhea is associated with a defect in the structure of the woman’s genital organs or the result of their surgical removal (aplasia of the uterus, ovaries, hysterectomy, removal of the ovaries, etc.). With a relative form of amenorrhea, restoration of menstrual function is possible.

Its false form is observed when the hymen becomes infected with the subsequent occurrence of hematocolpos, atresia of the cervical canal, which often results in the formation of hematometra, hematosalpinx, etc. The true form of amenorrhea may be associated with dysfunction of the hypothalamus, pituitary gland, ovaries, or uterine mucosa.

It can be primary (if menstrual function has never occurred) and secondary (its cessation after menstruation has occurred at least once).

Local causes include the absence of the vagina and uterus, ovarian tumors, destructive irreversible processes in the uterine mucosa, etc.

Common causes of amenorrhea include: Acute infectious diseases (typhoid, pneumonia, sexual and extrasexual sepsis, articular rheumatism, etc.), in which it is temporary and does not always require special treatment.

Chronic diseases (tuberculosis, severe anemia, heart valve defects, kidney disease, thyroid disease, hypertension, etc.). In these cases, treatment aimed at eliminating the underlying disease is indicated.

Severe intoxication with lead, drugs, alcohol, nicotine.

Deep nutritional disorders (hunger, malnutrition, insufficient or qualitatively poor nutrition with a deficiency of vitamins, proteins, fats or carbohydrates). The same group of etiological factors for amenorrhea includes metabolic pathology, accompanied by general obesity.

Neuropsychiatric disorders (grief, fear, confusion, severe mental illness). E.D.

Svet-Moldavskaya distinguishes two types of amenorrhea in patients with mental illness: a) in patients with schizophrenia and epilepsy and b) due to traumatic, involutional and alcoholic psychoses.

In patients of group I, there is no disturbance in the estrogen balance, there is no atrophy of the genital organs and the uterine mucosa, ovulation in the form of “hidden cycles”, there is an increased secretion of leucorrhoea and hypersexuality.

It is quite clear that the administration of estrogen hormones for therapeutic purposes in this category of patients is contraindicated.

In patients of group II (amenorrhea due to chronic intoxication), trophic disorders of the genital organs, decline of hormonal and sexual function, and an insufficient amount of estrogen in the body are observed. Along with general therapy, estrogen treatment is indicated for them.

Wartime amenorrhea is considered a pathological condition. During the Patriotic War (1941-1945), the number of women with amenorrhea, according to M. S. Malinovsky, increased 15-20 times compared to the peace period. E.I. Kvater identifies 3 main factors for the occurrence of wartime amenorrhea: nutritional, psychoneurogenic and fatigue factor (mental and physical).

It lasts 3-4, sometimes 8-12 months and in most cases occurs without symptoms of loss of ovarian function, in the absence of structural changes in the uterine mucosa. After some time, menstrual function usually returns to normal, but such women often experience decreased sexual sensation.

Wartime amenorrhea does not require special treatment, with the exception of women who simultaneously have uterine hypoplasia, as well as girls during the period of establishing the menstrual cycle.

Endocrine disorders are the most common causes of amenorrhea. In this aspect, primary dysfunction of the hypothalamus and pituitary gland, as well as primary dysfunction of the ovaries, should be considered.

Amenorrhea due to disturbances in the hypothalamus as a regulator of menstrual function is mainly the result of influences of an emotional nature. The origin of such forms of amenorrhea is explained by a change in the function of the “diencephalic center” that regulates hormone metabolism (E. I. Kvater, 1965).

In this case, there is a decrease in adrenal function, asthenia, decreased excretion of 17-ketosteroids, and a decrease in basal metabolism; c) Sheehan syndrome, in which, in addition to amenorrhea, there is mild vegetation on the pubis and axillary areas.

These phenomena are the result of thrombosis of the vessels of the anterior lobe of the pituitary gland, which occurs during sudden blood loss during childbirth or in the early postpartum period;

d) hypotituarism resulting from a pituitary tumor.

The development of amenorrhea due to dysfunction of the hypothalamus or pituitary gland, between which there is a close anatomical and functional connection, requires special examination. Such patients should be examined in the most detailed way in the appropriate hospitals (gynecological, endocrinological, neurosurgical, etc.).

It must be borne in mind that with primary damage to the hypothalamus - pituitary gland, there is a combined damage to the ovaries and uterus, the functions of which are interrelated.

Consequently, when figuring out the main cause of amenorrhea and the primary damage to one or another internal secretion organ, one must remember that its cause may be a primary damage to the pituitary gland - the hypothalamus, ovaries and uterus as an afferent organ.

If the cause of amenorrhea is primary damage to the ovaries, then in such cases a gradual decline in their function occurs.

Due to underdevelopment of the ovaries and insufficient formation of estrogens, the uterus develops poorly (insufficient size is noted, the mucous membrane is poorly developed, the function of its interoreceptors is reduced), as a result of which the perception of hormonal impulses by this organ is reduced, even if estrogens are introduced externally in sufficient quantities.

For the onset of menstruation, not only the normal function of the hypothalamus-pituitary and ovarian system is necessary, but the endometrium must also respond to hormonal impulses emanating from these organs.

Even in cases where the hormonal balance corresponds to physiological norms, and endometrial reception is absent or reduced, the so-called uterine form of amenorrhea is observed.

It is observed in infantilism, advanced inflammatory processes of the uterine mucosa, after curettage with removal of the basal layer of the endometrium and the formation of synechiae in the uterus, the cavity of which sticks together, etc.

Depending on the severity, 3 degrees of amenorrhea are conventionally distinguished. With I (mild) degree, the absence of menstruation for no more than 1 year, loss of ovarian function is not yet observed, but the size of the uterus is reduced, the length of which, when measured with a probe, is 5-5.5 cm.

• Stage II (moderate severity) lasts from 1 to 2 years, symptoms of prolapse, ovarian function may appear, the length of the uterine cavity is reduced to 5-3.5 cm.
• III degree (severe form) is characterized by the absence of menstruation for more than 2 years, a sharp decrease in the size of the uterus (3-3.5 cm) and severe loss of ovarian function.
• Hypomenstrual syndrome occurs mainly due to the same reasons as amenorrhea, but their influence is significantly weakened.

Clinically, it manifests itself in the form of: hypomenorrhea - scanty menstruation with a constant rhythm; oligomenorrhea - short, short menstruation (1-2 days) with preserved normal rhythm and opsomenorrhea - rare menstruation (after 6-8 weeks). A combination of these manifestations of hypomenstrual syndrome is possible.

With amenorrhea, various changes are observed in the ovaries and uterus depending on the severity and duration of the disease. In mild degrees, there may be no clinical and anatomical changes in the uterus and ovaries; in grade II, there may be changes in the ovarian parenchyma, but follicle growth is observed.

They grow and, before they have time to mature, undergo physiological atresia. Often in this situation, the process of atresia is cystic in nature, as a result of which growing, cystically degenerated follicles accumulate in the ovaries (small cystic degeneration of the ovaries).

With severe degrees of amenorrhea (III degree), pronounced pathological changes are found in the ovaries and uterus.

In the ovaries, complete functional inhibition is observed (there are no maturing and atretic follicles); the uterus is sharply reduced in size and, due to wrinkling of the retractors, occupies a retroversio-retropositio position, the functional layer of the mucous membrane is absent, and the basal one is in the stage of fibrous degeneration. The vaginal part of the cervix is ​​shortened, the vaults are flattened.

• Diagnosis of amenorrhea
• Treatment of amenorrhea and hypomenstrual syndrome

Source: http://www.medical-enc.ru/ginekologia/patologicheskaja-amenoreja.shtml

Amenorrhea. Lack of menstruation. Causes and treatment of amenorrhea

Amenorrhea (from the Greek a - negative particle, men - month, rheo - flow) - the absence of monthly bleeding (menstruation) in a woman.

Amenorrhea may be:

• Primary, if menstruation has not appeared even once during the woman’s entire life,
• Secondary, if they recurred for some time and then stopped for a long time or completely.

Amenorrhea can be a physiological during some periods of a woman’s life:

• before puberty (up to 12-14 years),
• during pregnancy, during breastfeeding,
• after the onset of menopause (after 45-54 years).

In all other cases, amenorrhea is a pathological condition.

Pathological amenorrhea can be:

• Temporary , transient, if menstruation reappears after a more or less long absence,
• Constant , persistent, when menstruation stops forever.

Causes of primary amenorrhea.

Permanent Pathological amenorrhea can be a consequence of diseases or malformations of the female genital organs - the uterus and ovaries:

• Genetic disorders;
• Disturbance in the hypothalamic-pituitary system, which regulates the normal menstrual cycle (hypothalamus-pituitary-ovaries-uterus);
• Developmental disorders of the genital organs (with severe underdevelopment or aplasia of the uterus and ovaries);
• The so-called False amenorrhea also occurs, for example, due to inflammation of the hymen or vagina, when menstrual blood is retained and accumulates in the vagina, and subsequently in the uterus. In this case, the ovaries function normally, but due to obstructions, blood cannot come out.

Causes of secondary amenorrhea.

Temporary Pathological amenorrhea can be associated with various general diseases of women:

• For severe infectious diseases (typhoid, tuberculosis, sepsis, malaria, etc.),
• general exhaustion, sudden weight loss,
• Blood diseases (chlorosis),
• Metabolic disorders and diseases with damage to the endocrine glands (diseases of the thyroid gland - hypothyroidism, thyrotoxicosis, adrenal glands, obesity, diabetes, acromegaly, etc.),
• In case of poisoning of the body with lead, phosphorus, nicotine, morphine, alcohol.
• Amenorrhea can occur after an induced abortion, after cauterization of the uterine mucosa with iodine and other means.
• With polycystic ovary syndrome, exhausted ovarian syndrome, various ovarian tumors;
• With a tumor of the pituitary gland - prolactinoma (a benign tumor leading to an increase in the hormone prolactin in the blood);
• In some cases, temporary amenorrhea occurs due to excessive fatigue - physical and mental (for example, among students during exams), due to neuropsychic experiences, severe stress (fear, fear). This includes “wartime” amenorrhea.

The listed diseases have a depressing effect on the activity of the ovaries, in which the process of maturation of eggs stops, which inhibits the onset of menstruation.

Permanent Pathological amenorrhea can be caused artificially:

• for example, after removal of the uterus, ovaries,
• after irradiation of the ovaries with X-rays, used in the treatment of certain female diseases.

The possibility of restoring menstruation after more or less prolonged amenorrhea depends on the nature and extent of changes in the ovaries and uterus, if the maturation of eggs in the ovaries resumes and the uterine mucosa is restored.

At the same time, often reappearing menstruation is scanty and repeats at longer intervals than usual, which is associated with delayed maturation of the egg in the ovaries (a similar type of amenorrhea is observed in women of the Far North during the polar night).

In some cases, amenorrhea is not accompanied by painful symptoms. Sometimes there are complaints of “hot flashes” to the head and face, followed by chills, cold sweats, and tinnitus, as is observed in some women during menopause.

Diagnosis of amenorrhea.

• Examination by a gynecologist;
• Ultrasound of the pelvic organs;
• Blood test for hormones (FSH, LH, E2, Prl, free Tst and other necessary hormone tests);
• Hysteroscopy;
• Endometrial biopsy;
• Blood test for thyroid hormones (TSH, T4, T3);
• Biochemical analysis of blood glucose;
• If prolactin is elevated and a tumor of the pituitary gland is suspected, an X-ray of the skull, CT and MRI of the brain are indicated with the obligatory consultation of a neurologist;
• In primary amenorrhea, the karyotype (sex chromosome structure) is determined.

The scope of diagnostic tests is determined by the gynecologist after examining and collecting a detailed medical history of the patient.

Treatment of amenorrhea is a difficult task and should be aimed at eliminating the causes or mitigating their influence. Treatment depends on what is the underlying cause of the amenorrhea.

• For “false amenorrhea” when the hymen or vagina is closed, adhesions in the uterine cavity, or cervical canal, surgical treatment is indicated. Pituitary tumors are treated with surgery and radiation therapy.
• To treat infertility, patients with polycystic ovary syndrome are advised to undergo laparoscopic surgery to restore normal ovarian function.
• After this, hormonal therapy is prescribed.

General measures for secondary amenorrhea:

• Good nutrition and exposure to fresh air,
• Normal work and rest schedule,
• Avoid and cope with stress whenever possible,
• Moderate exercise
• Treatment of common infectious and other diseases that cause amenorrhea.

For some causes of amenorrhea, all these measures can normalize the menstrual cycle without hormone therapy.
But if this does not happen, then for all types of amenorrhea, long-term Hormone Replacement Therapy (HRT) to stimulate normal ovarian function. Treatment tactics for amenorrhea depend on the form and severity of the disease.

When treating amenorrhea due to underdevelopment of the uterus or decreased function of the pituitary gland and ovaries, a temporary blockade of the hypothalamic-pituitary system , then stimulation with combined estrogen-gestagen drugs.
To restore the menstrual cycle, several courses of hormonal treatment are necessary.

Drugs are used that stimulate the maturation of eggs and affect ovulation. In parallel with hormonal therapy, physiotherapeutic procedures are also carried out.

 

Medicines for the treatment of amenorrhea:

• Estrogens (Folliculin, Divigel, etc.) – for endocrine disorders of ovarian function and for teenage girls with delayed puberty (in the absence of other pathology);
• Gestagens (Pregnin, Duphaston, Utrozhestan, etc.) - used for both primary and secondary amenorrhea;
• Gonadotropin-releasing hormone agonists - GnRH (Decapeptyl, Zoladex, Buserelin, Diferelin) block receptors of releasing hormones in the pituitary gland - are used to treat patients with polycystic ovary syndrome. These drugs are also used to treat primary amenorrhea caused by disorders of the hypothalamic-pituitary axis;
• Combined estrogen-progestogen oral contraceptives (COCs) are prescribed for polycystic ovary syndrome (Logest, Zhanin, Ovidon, Novinet, Rigevidon, Miniziston, Anteovin, Triziston, Triquilar, etc.).
• Synthetic non-steroidal drugs - Antiestrogens (Clomiphene, Clostilbegit, Clomid, Serofne) - are used to treat infertility in women with secondary amenorrhea; the drug causes ovarian hyperstimulation.

The duration of hormone treatment varies depending on the specific situation.

After eliminating, to the extent possible, the main cause, Physiotherapy as a general strengthening measure and to increase hyperemia of the pelvic organs. If bleeding occurs, the procedure is interrupted.

• Galvanization of the “collar” zone according to Shcherbak . Recommended for primary amenorrhea of ​​central origin.
• Galvanization of the cervical-facial zone (Kellat technique) is used for amenorrhea of ​​central origin with manifestations of spasm of cerebral vessels.
• Endonasal electrophoresis of a 2% calcium solution is prescribed for genital infantilism combined with hypermenorrhea.

When electrophoresis is applied to the collar and cervicofacial zones with vitamins, there is a direct effect on the hypothalamic-pituitary region and the function of the nerve centers is stimulated.

• Galvanic “panties” according to Shcherbak for the lumbosacral region are recommended for use in amenorrhea of ​​ovarian origin with normo- and hypoestrogenism, amenorrhea of ​​uterine origin.
• In case of ovarian hypofunction, copper electrophoresis to the ovarian area.
• Electrophoresis of novocaine, zinc, and thiamine is also used

Source: https://www.medglav.com/ginekologicheskie-bolezni/amenorea.html